Adventures in Child Neurology

>”I thank God every day for making me a Yankee.” – Joe DiMaggio

So reads a giant bronze plaque on the outer facade of Yankee Stadium. I am sure that must also be the heartfelt sentiment of one Derek Jeter. I denied myself of the first two World Series games to study for our last Anatomy exam but I have savored every pitch of Games Three and Four, and what games they were! One of my all-time favorites, Roger Clemens, coming up with a huge effort in game three with the Yankees’ backs to the wall. Some of my most unforgettable baseball memories are of the Rocket and he added another one Tuesday night.

And then Game Four. Are you kidding me? This was one of the greatest World Series games ever. Tino Martinez with a two-run job with two out in the bottom of the ninth to tie the game. And then, the New Pride of the Yankees, Derek Jeter wins it in the tenth inning, with only his second hit of the series, a blast down the right field line to the part of the park built for the Babe himself. There were his Mom and Dad cheering him from the stands. This guy calls his manager, “Mr. Torre.” How can anyone not like Derek Jeter? The cut-off play he made in Game Three of the Divisional Series against Oakland to save the game was unreal. Then he makes a spectacular play in Game Five of that series diving into the stands to catch a foul pop. With an aching back from that play he goes just 2 for his next 23 until the game-winning homer against the Diamondbacks. Watching Derek Jeter play baseball is as good as it gets.

I am not pulling for the Yankees because of the terrorist angle. I am not even really for them because I love Clemens, Jeter, and O’Neill. I am for the Yankees because they represent an absolute. Their most current dynasty gives me comfort by demonstrating that there are things in this world you can count on. Don’t get me wrong, if my Reds were going against them, I would be cursing the Bronx Bombers, but with no attachment at all to the Diamondbacks, I find myself in hopeless admiration for what these Yankees have done since 1996. Derek Jeter played his first full season winning the American League Rookie of the Year Award in 1996. He is now playing in his fifth World Series in six years and is two games away from winning ALL of them. Only a fool would bet against him.

Okay, back to medical school topics! I ate lunch today, along with about 15 other first year students with Dr. Wallace Conerly, the vice chancellor of health affairs at the University. He spends one day a week eating with students to pass along information and get feedback. He gave us some history of the University and told us about some of the research going on. The school’s research budget this year is $64 million. Some of the projects are super high-tech and fascinating. NASA has contracted the school to develop imaging systems for real-time surgical consultation. Conerly told us that the mindset of NASA is that they ARE going to Mars with manned ships. This will involve YEARS of space travel for the round trip and inevitably medical problems will come up that require data feeds from medical personnel on Earth. UMC is a leader in this technology and currently has been testing systems where surgeons here digitally monitor micro surgeries being performed in Japan. Also research is being done at UMC on cellular functioning in zero-gravity environments. Of course these are the fringe things. Most of the dollars go toward cardiovascular disease research with cancer research following that.

Only one more month of Gross Anatomy! I should get my pelvis and lower limb exam score back tomorrow, so check in for the gory details!

>The recent lack of activity on my site has been due in part to a cracked bone in my arm I suffered a couple of weeks ago. During one of my gang’s regular Sunday battles, I went down hard on my outstretched hand. The force on the distal end of radius forced it back into the capitulum of my humerus, giving me a head-neck fracture, thankfully with no displacement. Ugh. I can tell I am too emotionally involved with Gross Anatomy! What I meant to say is I cracked my elbow and it hurt like a son of a gun.
I had to keep it in a sling for a week so the bone could begin to mend and after a week the doctor told me to start trying to get some movement with it. I also severely strained the collateral ligament which surrounds the elbow and motion has been extremely limited and painful. I still can’t extend or flex it all the way and I can’t rotate my forearm, but I can type fairly comfortably now. Please don’t write and tell me how I’m not young anymore and I have to be more careful! I have heard that enough to where I’m ready to puke. If anyone suggesting that I should give it up can come over here and beat me one-on-one on my home court I will consider it.

School has not really been affected all that much except I didn’t have to do any dissections for a few days. I just held tissue out of the way with my good wing and watched my lab partners work on our cadaver’s now trunkless legs! Angie has been a little bitter about not getting much help lifting Manning though. Oops. Sorry Angie, but I’m back now! Also very special thanks to John B who graciously swapped vehicles with me since I could not drive my stick-shift!

Our third and penultimate exam was given yesterday and I think I did pretty well. The test was on the pelvis and lower limb and now all that we have left is head and neck. We hardly have time to rest though. After our exam last night, we had a study guide for the skull in our mailboxes. The handout is on the Osteology of the skull and is twelve pages on just the bones and features of them in the skull! Today in lab they will assign each of us a skull and we will do four hours of just studying the bones. I am very excited to be three-fourths done with this traditional medical school rite of passage!

>We had our second Gross Anatomy exam on Monday and it was just as tough as the first one. It covered the thorax and abdomen or in my kid’s term, “the guts.” I put 3 times as much effort into this one as I did the first one and was feeling very good about it going into the test. I felt like I was prepared enough for an A but after that bad boy I am quoting the mantra of many of my classmates, “C = MD.” That is a little joke that runs around the student body to remind us that we just have to keep our head above water and maintain the magic 70% level in Anatomy to eventually get our MD. Virtually everyone was crying about how hard this test was. We should get our grades tomorrow so, I’ll know what the damage was. It is extremely frustrating to spend so much time studying and then still not feel good about it when the exam is over. It is really a grueling course. And it never lets up. The day after our exam, we started the next unit on the pelvis and lower limb. The dissection for Tuesday was titled, (as Dave Barry would say, “I’m not making this up!) “The Anal Triangle.” A day after we all got our butt kicked we are having to carve somebody else’s up. Ah, irony!

In Biochemistry we are having some great lectures on stuff I am really interested in – genetic coding in DNA and how our DNA is the blueprint for all of the proteins that our cells make and determine who we are. Unfortunately I feel so far behind after devoting the last week to Anatomy that I feel rushed to catch up. All of the second year students tell us that once we are through with Gross Anatomy (November 30 – only 51 days!) that it will all be downhill for the first year. I hope they’re right!

There are several other little catchphrases that many in the class use that I like. One that sticks in my mind is, “Give me a take home lesson!” One of the professors likes to use this phrase in his lectures to highlight key points and will say something like, “Now the take home lesson here should be that DNA polymerases must have a template.” All of the students will then dutifully write this fact down and star it in their notes as a likely test question. We have applied the phrase now to any thing likely to be on a test and I will frequently hear students ask other professors to “give us a take home lesson!”
Oh yes, we had our first casualty this week. A guy who I had gotten to be friends with had to withdraw and take a leave of absence. Hopefully he will come back next year. It was a little sobering to me. If you’re reading this, my man, I wish you well!

>We have been in school for six weeks now and it has gone like a whirlwind. The last week has been very tranquil despite the pressures of upcoming exams. The weather has been so beautiful that I have spent a couple of days lying in the grass under a tree while studying and eating lunch. I have got it made!

Biochemistry is running smoothly. We had our second exam on Friday. I did not do as well as I did on my first test but still have a solid B average. A topic on our last test was cell membranes the way materials are transported across membranes for protein synthesis. Many of our cells are like tiny manufacturing plants that are running 24 hours a day. There is constantly chemical and electrical activity going on at the cellular level. And the amazing thing is that we have figured so much of it out. Just think about it – the neuron cells of our brains have assembled themselves in such a way that they can “know” what they are doing. That is an incredible idea to me! For our next exam we are starting to get into a subject that has always fascinated me – DNA coding. With the mapping of the human genome in the last year this topic is hotter than ever. We will be doing amazing things in the next few decades with our new knowledge.

In Anatomy we are doing the thorax and abdomen. We had to dissect the heart and lungs out of our cadavers and examine them in detail. Now if I ever threaten to rip somebody’s lungs out, I can speak from experience! Healthy lungs look and feel really cool even in the cadavers. The texture is so pleasing to me that I could hardly stop playing with them. On the other hand, diseased lungs are some of the most disgusting things you can look at. I don’t see how anyone who has ever seen the lungs of someone with emphysema could smoke cigarettes! One cadaver in the lab had lungs which had pretty much liquefied. Our second anatomy exam is a week from today and I definitely need to eat, drink and sleep this stuff for the next seven days to recover from that first test!

>The results of my first Gross Anatomy test last week were just that … gross. A lot of us were in the mode one of my classmates called “damage control..” We knew we were not well enough prepared so we just were hoping not to dig ourselves too big a hole to climb out of on the next exam.

Our next exam is on the thorax and abdominal cavities. We have opened our cadaver up and examined the heart and lungs in the last week. It is really amazing to see. The heart is really fascinating and we have opened up each of the compartments and poked around inside. I have learned how ignorant I was about some things. I always imagined that a coronary bypass operation was needed because one of the major vessels coming from the heart was blocked, i.e. the aorta or the pulmonary arteries. It turns out though that you have these much smaller arteries that circumflex the heart itself supplying blood to the external muscles of the heart. It is these arteries where blockages sometimes occur causing the muscles of the heart to die.
It seems everyone in the lab ends up being freaked out about one thing or another. A girl in my group is really disturbed by the liquefying of some of the cutaneous fat on the body while cleaning the body. It starts out as yellow solid tissue but as you scrape it, the fat will sometimes just kind of melt and look like the fat in chicken soup. Some others are really disturbed by some limbless specimens that are stored in some of the tanks to let us study spinal cord structures that we will not dissect out on our own cadavers. None of that really bothered me but when I saw the grape jelly looking congealed blood still in the now dead heart I kind of got queasy! Gross!

>Four weeks of Med School are now over, and I can’t believe how much I have learned. We got our Biochemistry exam results back and I did quite well. After thinking it over, I have decided I won’t post my actual scores here. Partly because I don’t want to be seen as bragging on the good ones, but mostly because I don’t want to be embarrassed by the not so good ones which are sure to come at times! Which brings me to Gross Anatomy. Yikes! Our first exam is Monday. I have been told that about 50% of last year’s class failed the first exam. It only counts as 15% of our final grade though, so there is still a lot of time to recover. Most of us have never had a course quite like this so I guess an adjustment period is to be expected. I have a lot of studying to do this weekend. Unfortunately I have a lot going on. See the Manning Update for details.

Much of this week has been squandered. Like everyone else in America, I have been keeping watch on the news of this week’s incredible events. The sight of the Twin Towers collapsing was to me even more shocking than the footage of the plane crashing into the second tower. It looked almost like the controlled demolition of the Seattle Kingdome a year ago, but realizing that there were still people in and around the building made it horrifying. The symbolism in the image was powerful too.

I don’t mean to sound callous but I am glad that all sporting events were cancelled this weekend so I can concentrate on preparing for this test! Those college football games are an irresistible draw for me!

>The third week of Medical School culminated with our first exam. It was in Biochemistry and I think I did well. I spent a good portion of my study time preparing for it, and while I feel like it paid off, I now find myself a little behind in Gross Anatomy.
The test consisted of 51 multiple choice items and will only count as 9% of our final grade for the course. I feel like I should definitely be in the 80s on it but apparently it will be a few days before we get our scores back. I have been told that the professors like to statistically analyze the results to check for ambiguous questions and such before giving you a final grade. I also have learned something I find a little unusual about the grading system at UMC. It is entirely numerical. There are no letter grades such as A, B or C. You must make a 70% in each course to pass and maintain an overall average of 75% to advance to second year. Instead of dividing the class by means of A’s and B’s and such, progress for each student is measured by what third of the class you rank in. In other words, the high performers are noted to be in the top third of the class and so on. I have heard that many medical schools in the country are going away from grades and having only a pass/fail system. I really don’t like that system, as I get a lot of motivation from the idea of competing with my classmates for rankings. I have heard many of them say things like, “I don’t expect to be in the top ten, I just want to be in the top half,” or “I just want to pass!” I want to win though! I want to be first in the class, and if I’m not I want to be second, and if I’m not in the top 50 I want to be number 51! Going in to this test I felt a little bit at a disadvantage to many of my classmates who had a Biochemistry class in their undergraduate education. I got the impression that many of them were sort of blowing off this course and concentrating on Gross Anatomy. In fact I’ve heard many comments to the effect that Biochemistry was going to be relatively easy, and that they just hoped to get a passing grade in Anatomy. When we go get our grades, a histogram of the entire classes performance will be given, so I am interested to see where I will rank.

After the exam Friday morning, I realized that even though I had that euphoric feeling I always get when a test is over (I really got to love that feeling taking Actuarial exams over the last 10 years!), I had no time to celebrate and needed to get to work right away on Anatomy. My fears were confirmed Saturday morning. We had a “practice” practical exam first thing Saturday. Our first real exam is next Monday, and the examinations in Anatomy are comprised of a written portion and a practical portion. During the latter, each student goes through the laboratory and has to identify structures that have been tagged on all of the cadavers we have been working on. Since most of us were a little unsure of what to expect on these exams, the professors gave us a little dry run through one. I definitely learned one thing … I have a LOT to do this week!

>What an opportune time for a three day weekend! I felt like it was a great time to try to sit back and assimilate everything that has been thrown at me in the first eight days of classes. Even though I don’t feel like I am on top of everything, I am amazed at how much new knowledge I have acquired in such a short time. I am obsessing over the material so much that I wake up in the morning thinking about anatomical structures and names. When I see people, I look for the surface landmarks of their skeletal systems. When I pointed out Kathy Bourgeois’s acromion this weekend, she told me enough was enough! I have spent most of the three days catching up on material and reviewing. I feel a little bit like I have lost touch with the outside world. I haven’t read a newspaper in two weeks and I only glance at the baseball and football scores. And actually, I am enjoying it all so far!
I took a break tonight to go over to our friend’s the Bourgeois’ for a cookout and the Mississippi State game. It was great to sit down with friends and relax after putting in about 18 hours of studying this weekend. Thanks, John and Kathy!

I have found one pleasant diversion that I like to indulge myself of each day. The school has an excellent little gym in the student union and I have been getting to school early enough to workout and shower before my 9:00 BioChem class. I have been lifting weights and then riding a stationary bike for 20-25 minutes. I allow myself to read whatever I want while on the bike. Right now it is a Ken Follet novel, A Place Called Freedom. The day then falls into a nice routine. We have just and hour of BioChem most mornings and then three hours to study until Anatomy starts at 1:00. We then have an hour and a half or so of lecture before going to the lab to do our dissections. I am in the lab until close to six before coming home to strip off my, by then, stinking scrubs. It is funny to get on an elevator with some of the residents and watch their noses turn up as they say, “Oooh! Gross Anatomy! You won’t remember anything you learned, but you’ll never forget the smell!”

Our first BioChem exam is this Friday. We have covered intro to cellular structures, pH equations in physiological conditions, protein structure, myoglobin & hemoglobin, and enzymes. I really like this class and am amazed about how much is known about the molecular structure of so many proteins. Just a common one like hemoglobin is incredible. Your body has two different sites in your DNA that code for hemoglobin synthesis. Two different peptide chains (strings of amino acids) are formed and a pair of each are covalently bonded together into a tetramer (4 piece) protein molecule. Within this molecule are four iron atoms that can bind with oxygen molecules. In your lungs, the hemoglobin binds with oxygen to carry it in your blood stream to the tissues where it is needed for metabolism. The oxygen molecules are then unloaded and carbon dioxide takes their place in the hemoglobin and is returned to the lungs to be exhaled. The hemoglobin synthesis is critical. Sickle cell anemia is a genetic disorder that is marked by an error in one single amino acid of the hemoglobin chain. The mutant gene is usually not a problem in individuals who only have one inherited sickle cell gene, but if they get one from both parents, they will have sickle cell anemia.

In Gross Anatomy we have dissected the back, the chest, the axilla (the armpit … there is a LOT more going on in there than I ever suspected!), and the arm. We will be doing the shoulder and hand before our first exam two weeks from today. I don’t feel as good about this class yet. There is SO much reading to do. As one professor said, we are learning a whole new language as well as the structures involved. I still have to stop and think about what “superolaterally” means when they use it to describe a direction on the body.

>Are you kidding me!?! The pace we are on after just four days of class is incredible. Each day it seems you have a huge amount of new material to digest and then the next day they double it. The first few days I have vacillated between feelings of panic and confidence I have a handle on things. If all of my classmates didn’t seem to be in the same boat, I would be worried that I was in over my head, but everyone is fighting the same feelings it seems. And it actually has gotten better now that we have had a weekend to catch up a little.

In Biochemistry we started reviewing some concepts from undergraduate chemistry. Unfortunately I have not had physical chemistry in some 15 years! While many in the class were having trouble with the algebra of solving pH problems, I was struggling to remember how the reactions would go so I could set up my equations. I went from feeling like I had a huge advantage on the mathematically challenged folks around me to realizing that I couldn’t write an equation to solve if I didn’t know which chemical was the acid and which was the base. And some of those pesky compounds can be either! But after a weekend of serious reading, I have my confidence back.

In Gross Anatomy we have already dissected the superficial and the deep back muscles. I know where to find the levator scapulae (my favorite muscle name) and can identify a subcutaneous branch of the dorsal rami of the spinal nerve. Our class is divided into groups of four. I am working with two other guys and a girl. Following an apparent long standing Gross Anatomy tradition, we first had to come up with a name for our cadaver, an elderly white male. We settled on “Rupert.” The professors have really stressed the importance of respecting the dignity of the people who have donated their bodies to science. No longer do most schools accept bodies of indigents and unclaimed corpses. All of the 35 or so cadavers in our lab were donated. Dr. Moore, the head instructor has reminded us that these are not just chunks of flesh to cut up, but the remains of real people. Someone loved them and they loved back. They have given us a great privilege and by the end of the semester we will know things about our cadaver that he never knew himself.

Nobody in our class has freaked out or anything and had to withdraw yet. I always thought the first few days of Anatomy were supposed to chase a few people out, but apparently the admissions committee screened for squeamishness pretty well this year!

We got a few class statistics the other day. We have 107 first year students, 7 of those repeating their first year. 25 different undergraduate institutions are represented with 10 being from in state and 15 out of state including Yale, Notre Dame, and Cornell. Their are 34 females and 73 males, I believe. The youngest is 20 years old and the oldest is 44. Average age is 24.6 and the average MCAT was a 28.3. The class is really diverse and I have met all kinds of interesting folks. One guy has been a catfish farmer for 22 years. There is a girl who played basketball for the University of Memphis. The 20 year-old is a home-schooled wunderkind. And on it goes …

Tonight we had a real nice time at a catfish and chicken buffet dinner at the Ag Museum. The Mississippi Association of Family Practitioners sponsored it and the whole family was invited. There was a clown and face-painting for the kids and a good time was had by all. Unfortunately it took away from study time. I have found that you simply can’t afford to take a night off!

>”Toto, we’re not in Kansas anymore!” That’s what Fourth Year class president Will Dabbs told our class he thought his first week in Gross Anatomy when he saw a diminutive classmate of his, strolling across the dissection lab with a human leg draped over his shoulder like some kind of bizarre rolled-up carpet. Will gave the first years a motivational talk and encouraged us to “suck it up” and hang in there when the inevitable doubts creep up on us in the next few months. He said everyone will go through the stage where they wonder what in the world they have gotten themselves into. But we each owe it to the two people bagging groceries who wanted our slot, but didn’t get in this year, to not quit. He told us it would “suck to be us” for the next two years, but if we could get through that it was downhill from there.

It hasn’t taken me that long to get my first reality check. When I saw our reading assignments for the rest of the week, I knew we were in “game on” mode. First year lasts 40 weeks and there is a LOT of material to cover. Someone had told me trying to learn all of the material in the time allotted was like trying to drink water from a fire hydrant, and I can already see what they mean. If I hadn’t been warned so much already, I think I could start to slip into panic mode. And I’ve only had one day of class. We went to Biochemistry today and had an Introduction to Cell Structures lecture and one on pH concepts. The syllabus calls for 89 lectures, 15 clinical studies, 6 exams, a comprehensive final, and a standardized National Board step exam.

We have our first Gross Anatomy lab tomorrow. As preparation we were assigned about 80 pages of reading. We will begin by dissecting the back. Some of our reading discussed the proper techniques for “skinning.” We have Anatomy every afternoon but Wednesday, so on those days we will wear scrubs all day. You cover those with a lab coat and are required to launder the coat at least twice a week. I hear that they get pretty nasty!

Yesterday was the last day of leisure I feel like I will have in a LONG time. We finished our registration and orientation during the day and then had a “White Coat Ceremony” that evening. After a very nice meal, Dr. John Stone, a cardiologist and poet from Emory University in Atlanta spoke to us. He is a very good speaker and full of stories and poems. We were each presented our first white coat, symbolic of the new profession we are entering into. We also received a nice book which Dr. Stone co-edited called On Doctoring. It is a collection of stories, poems and essays by some of the world’s great writers. It looks great, but I don’t know when I’ll find time to read it.

Here’s a picture of me in my new white coat. Do I look like I could say, “Drop your pants, please?”