Sunday, September 29, 2013
These classrooms always have people in them. It's after midnight on Saturday night (Sunday morning) and every room has 2-3 people in it. Except for mine! Maybe I smell or something. I probably scare them away as I dramatically mouth the lyrics to the musical soundtrack I have on in my headphones.
Friday, September 27, 2013
I promise: this is the last long weekend we have until Thanksgiving. From here on out, my posts should be more consistent.
I'm happy to have the time though as we have our second histology test and our first histology practical on Monday. We are one of the few medical schools that still uses microscopes and thus one of the few that still has a practical exam for this field. Whether or not that's a good thing is up for debate...
The diagram to the right is my new version of the concept map I made during my post-bacc year, seen below with the overlapping cellular pathways highlighted. We don't (yet) need to know as much as I needed to know for that old class and the pathways we do need to know have either been described slightly differently or discovered to be in fact different in the intervening years. It's nice to have this foundation to build on!
Thursday, September 26, 2013
Tuesday, September 24, 2013
|A drawing from my Netter Atlas of Human Anatomy|
|Statue of Atlas at 30 Rock|
I think the most embarrassing part of the day was when I couldn't identify the item picked out on my cadaver - on my half of my cadaver! I had no clue what nerve they had picked out. No one else seemed to know either though, so that made me feel better.
TIL: Tests continue to suck.
Jamaican patties are quite tasty!
Saturday, September 21, 2013
|Click to go to the full sized map|
Thursday, September 19, 2013
I'm not sure what changed exactly, but histology lab didn't seem quite so useless today. It may have been that the subject matter, lymph tissue, was less familiar to me from a histological perspective, a fact that was helped by my profound inability to stay awake during the related lecture yesterday...
At lunch we had a guest panel about the Affordable Care Act (Obamacare) and how it will affect us as practitioners. It's been interesting seeing how doctors around here feel about that law. The consensus seems to think that the law has many problems that still need to be addressed and will dramatically alter how we practice medicine, but that anything is better than the system (or lack thereof) that we already had in place.
We also had a guest lecturer from NYU School of Medicine who came to present some case studies that illustrate health disparities endemic to our health care system that will be our job to help fix. Examples were of the poor, uninsured immigrant population who may have a (rightful) distrust of our system and of the homeless who are sometimes understandably non-compliant regarding follow-up orders.
TIL: Social workers are the unsung heroes of medicine (I already knew this but it bears repeating).
The high endothelial venules of lymph nodes and the venous sinusoids in the red pulp of the spleen are analogous structures that allow for the selective perfusion of blood into the lymphatic system.
Wednesday, September 18, 2013
Anyway, we had a fun New York moment in class today when our professor showed us an x-ray of a liver with many lesions and asked us what we thought was wrong. She decided to pick on a Yankee fan in the audience by asking him what the best baseball team in NYC is. He got the answer purposefully wrong, as the radiograph was of metastatic tumors (aka mets). For the rest of the lecture, whenever metastases were the correct answer, she continued to call on him and he defiantly answered Yankees every time to much
TIL: People that maintain a strict kosher diet can't eat your average filet mignon.
The radiologist member of our anatomy faculty, being militantly vegetarian, loves to point out where each cut of meat can be found in the human body. When we had her for the thorax block, she pointed out that the next time we eat ribs we'll be able to identify the three muscle layers, the connective tissue and probably blood vessels and nerves. Yummy!
Today she pointed out that filet mignon is cut from the psoas muscle which connects the lumbar (lower) spine to the femur in the upper leg and is responsible for various hip movements. She then explained with the help of one of the many yarmulke-wearing gentlemen in my class that this muscle technically isn't kosher because some nerve/tendon runs through/near it. The details were confusing and my follow-up research (seen below) didn't help.
|Translation of Genesis 32:32 - I asked for another translation, only to be more confused.|
To the Jewish folk I know out there: if you can clarify anything in this post, please comment!
Tuesday, September 17, 2013
A guy is stabbed through the middle of the chest. The most important piece of info we could glean from the picture was that the guy was alive and breathing. With this and the entry point location, we could piece together the most likely scenario playing out inside his chest. The knife was most likely (miraculously) wedged between the heart and diaphragm. Had it hit the heart it would have pierced the right ventricle (which would have killed him instantly or caused cardiac tamponade (which would have still killed him pretty quickly)).
A woman suffers blunt force trauma to the abdomen following a car crash. The CT scan shows a hematoma around the spleen. Where do you put a catheter to stop the bleeding while you repair or excise the damaged tissue? You find the celiac trunk coming off the abdominal aorta and then inject die to locate and block the splenic artery. But to be thorough, you must remember that the spleen can also get blood from anastomoses with the left gastric and left gastro-omental arteries. Depending on the location of the bleed, these other blood supplies could be important to the outcome of the case.
A soldier is shot with .22 rifle through the chest. How much damage does it do? Gunshots cause two types of damage: they create a hole following the flight path of the bullet, and they create a shockwave through the surrounding tissue, which can be just as damaging. With a high enough velocity round and a path along the anterior-posterior access, the shockwave may not have time to develop before the bullet exits the body, so you may only have to worry about the permanent cavity. If instead the victim is shot in the side, you will have to assume that extensive fragmentation and trauma from the shockwave will have occurred concentrically around the bullet's path.
TIL: How to place basic sutures and tie basic surgical knots. It's amazing how quickly I went from "I have no clue what I'm doing," to "I could do this in my sleep."
Special thanks to my sister Samantha for the distracting pictures. Please check out her blog too!
Friday, September 13, 2013
I'd like to start by reiterating that med school is awesome. Anyone interested in practicing medicine has been told by the old and jaded that it's not worth it - that medicine has changed from the glory days of the 50s or the 90s or last year. Never listen to these people. Find another mentor (who is preferably caught up on sleep) and don't stop until you track down someone who practices for the right reasons and will support your exploration of the field. I apologize in advance for those days when I'm the sad, tired representative of medicine, because I know this has happened before and will happen again. Anyone reading this has permission to give me a cold hard (hopefully figurative) slap to the face to remind me of how great I have it.
Anyways, today was fun and mercifully relaxing. We had a quick lecture on the male genital system with far too many cringe-worthy surgical videos and then a relatively simple dissection of the pelvis. I was done with classes on a beautiful Friday by 12:10!
TIL: ...our cadaver's name, age and cause of death.
An enlarged prostate is a pain in the butt, sometimes literally. It can block the urethra, grow into and plug-up the bladder, and/or push against the anterior wall of the rectum. The rectum is a surprisingly smart organ and can use pressure alone to deduce the consistency of its contents, allowing us to tell the difference between feces and gas. “But,” as my professor put it, “it don't speak prostate.” When the prostate pushes against the rectal wall, the rectum misinterpreters this as an ever present buildup of feces and signals you to head to the nearest toilet. However, since you have nothing to expel, you can never relieve yourself.
Pedunculated means extended from a stalk.
This last one comes with a warning: don't be stupid. You know how the Viagra commercials all recommend going to the doctor if one's erection lasts longer than 4 hours? Nothing actually happens at 4 hours. The reason they have that warning is because it takes 8-12 hours for tissue to die. Remember the tissue in this case is the penis itself(!), which is being cut off from circulation by the engorged erectile tissue. The only reason they don't tell the public the real timing is that stupid people would put-off coming into the doctor until hour 12 or 13 which is too late.
|Click to view the original|
TI(re-)L: Bad/Bid/Puma inhibit Bcl-2 which down-regulates BAX/BAK which causes Apaf to dimerize in the presence of Cytochrome C, activating Caspase-9, leading to the further activation of Caspase-3 which triggers apoptotic cell death, possibly preventing the development of cancer. Simple!
Thursday, September 12, 2013
Wednesday, September 11, 2013
Tuesday, September 10, 2013
Let's get this out of the way right now:
TIL: To remove a champagne glass from the rectum, you can fill the glass with plaster of Paris and a tongue depressor. After relaxing the anal sphincter and allowing the plaster to set, you can pull the glass out without breaking it. The more you know!
Today was awesome. Disturbing at times (see above), but one of the most inspiring days to date.
We started the day with an anatomy lecture on the urogenital diaphragm and the female perineum. We then dissected the same up in lab, which was not easy. This was one of those lessons for which the takeaway was that we can't really see any of the important structures, but we still need to know them. Also, cadavers do not assume the spread eagle position with ease, so we had to use wood blocks to brace the legs apart. Not exactly a tasteful position...
Today was also the first time we had to flip our cadaver! The only noteworthy thing about this is that the entire posterior surface of the body had filled with fluid and flattened against the metal table. When we first flipped our body, it was flat as a board from the thighs to the shoulders, except at certain intervals where the skin bunched up, like a poorly ironed shirt. After an hour or so, some of the curves of the skin returned, but it still looked rather boxy.
The highlight of the day was an extracurricular activity for which some members of my class volunteered to introduce students from the speech/pathology school on campus to the anatomy lab and our bodies. These students will be taking gross anatomy in January, but are typically totally new to hard sciences and lab classes, so to them, even with only a month of experience, we are the experts. This was the first time we were able to show off what we had already learned, while trying to de-scarify (that's a technical term) the idea of working with cadavers.
I had the bonus of getting to explore a new body because we had more than one student from our group and the adjacent body had no one. This made it so that I could explore the body right along with the speech/pathology students, and be genuinely enthusiastic when we discovered peculiar anatomy or pathology. I had a blast with this and really surprised myself as to how much I have already learned.
Wednesday, September 4, 2013
First and foremost, an election update! ...I lost. The streak continues! Well, I shall take solace in a quote from my favorite author:
“The major problem --- one of the major problems, for there are several --- one of the many major problems with governing people is that of whom you get to do it; or rather of who manages to get people to let them do it to them. To summarize: it is a well known fact, that those people who most want to rule people are, ipso facto, those least suited to do it. To summarize the summary: anyone who is capable of getting themselves made President should on no account be allowed to do the job. To summarize the summary of the summary: people are a problem.” ~Douglas Adams, from The Restaurant at the End of the Universe.
Secondly, in regards to my prior and upcoming lack of posts, we have, or should I say, had very little school this week, with Labor Day on Monday, a random study day yesterday and Rosh Hashanah starting tomorrow. In fact, the only class we had was our hellish 2½ hour long histology test this morning.
The test was brutal, in part because it covered so much material. Last year, the first histo test was the day after the first anatomy test and everyone bombed it. This year, in order to “help” us, they moved back the histo test to give us more of a gap - the only problem being that we now had 20 lectures and 6 laboratory sessions of material to study. That's about the amount of material we covered in an entire 10-week course at UCSB condensed into not quite 4 weeks.
I am cautiously optimistic that I passed, but I make no other claims.
TIL: If doctors make the worst patients, soon-to-be doctors are in training to compete for that title.
The bus to Ithaca from White Plains is really not too bad and fairly convenient. As with any long haul bus, the passengers are wonderfully diverse and entertaining. I met a man named Alan who looked very good for his age (he told me so himself), listened to a woman who started smoking a cigarette to try to jinx the bus into showing up, and was late to one stop because the bus driver got lost between the freeway and the depot and had to ask directions from people on the street to figure out where he was going.