anna in med school

1. Exercise is good; learning is neutral; stress is bad.  I would venture to say that my hippocampus isn’t doing so hot.
2. Contrary to popular belief, epilepsy is not caused by demonic possession, hysteria, or masturbation.
3. FDR had epilepsy.  Chief Justice Roberts has epilepsy.  I think we can, therefore, elect a president with MS.  Bartlet for America.  (Maybe I should stop living in a drama that has now been off the air for several years.)
4. I think I may have come across a good number of people with behavioral variant frontotemporal degeneration (symptoms include: loss of insight, inappropriate behavior, perseveration, inflexible behavior, overeating)…sounds like most medical students (kidding, kidding).

And sommo’ good news: my dad’s getting married!!!

Larry + Krystyna: congratulations, you crazy kids!

Remember that string of good news I wanted to document?  Well, six days prior to our first five-hour Brain & Behavior exam, it’s hard to think back on MDTI.  But, as motivation to myself as I feel somewhat paralyzed by a fear of failure, I would like to declare: I did, surprisingly, pass MDTI.  It was quite possibly my poorest performance ever on an exam, and I could not be more thrilled.

I opted to take the test on time so that I wouldn’t have it hanging over my head during this 10-week marathon of brains (hmm, sounds like the name of a really geeky quiz show).  It was my first morning (and the last for at least another week) off percocet; what a trip.  After the test, I went out to lunch, downed enough narcotics to kill a small animal, went home and fell asleep to West Wing while Eric did my dishes…have I mentioned how wonderful my classmates are?

A few days later, our class got an email from the course director saying that we all passed.  I don’t think I’ve ever had classmates come up to me specifically to congratulate me on passing…I might have worn my concerns over this test on my sleeve (to put it lightly).  My getting through this class was very much a team effort.  I don’t take for granted how fortunate I was to have friends taking care of me post-op (which included bedtime stories ranging from Christina’s rendition of Watch Out for the Chicken Feet in Your Soup [thanks for the book, Sass!] to Nathalie’s “story” differentiating the types of arthritis), a learning team sending me updates and including me in group assignments despite the fact that I was not in class, fellow MS1s coming out of the woodwork, offering me kind words, study guides or personalized teaching sessions, administrative staff and faculty encouraging and supporting me throughout (Penn rules!), family and friends across the country sending me loving notes and care packages.  Whew!–longest sentence ever, and I’m sure I still missed some acts of kindness.  My point is this: I don’t think I could have passed without you, or at least it would have been a lot less pleasant.

It’s hard to believe it’s been almost four weeks since the surgery, and my peers have not tired of me (or at least they’re keeping their mouths shut about it).  Doria comes over periodically to help with laundry.  Sara takes me for long walks across the city in place of our traditional runs down the Schuykill.  Jon, Eric, and Christina parallel study and encourage some fragment of productivity on my part.  Anant listens to me as I emotionally disintegrate.

And you, readers, whoever you are, thank you.  My posts have leaned toward tirades of complaints and embarrassing moments self-pity (this post was initially just supposed to be a few sentences announcing my continuation as a student in “good” standing…and look what it turned into).  I’m less than pleased with myself, but sharing this past month with you has been incredibly cathartic, and I cannot tell you how touched I am that more readers have “hit” these update posts than any others in the past.  Thank you.

Arm update: I can now bend over and let my right arm hang at a right angle to the floor.  While standing upright, I can abduct my arm about 45 degrees.  Booyah!

Lecture notes are boring.  I mean, it’s the nature of the beast, right?  We’re asked to learn as much as possible in as little time as possible…that doesn’t allow much room for flowery writing.  I’ve gotten so used to bare-bones sentence fragments for literature that I really take notice any time there is a hint of sentiment.  In our lecture notes on vascular neuroanatomy from last week (note italicized segment):

Occlusion of the proximal or midbasilar artery will result in infarction of the pons.  Usually this leads to bilateral damage.  The infarcts are often shaped irregularly, depending on individual variation in collateral blood supply.  Severe bilateral injury usually leads to coma and death.  An even worse situation is extensive bilateral damage to the ventral pons with destruction of descending motor pathways, but preservation of the dorsal pons, allowing for relatively normal function of the reticular activating system and consciousness.  This is called “locked in” syndrome, in which the patient is awake but cannot move anything at all, except perhaps look up (this function lies in the dorsal midbrain).

Reading over this slide on Sunday sent me into a trailer- and clip-watching frenzy.  The Diving Bell and the Butterfly is a film I was supposed to see years ago, but I’ve kept dragging my feet.  The book upon which the film is based was written by Jean-Dominique Bauby, the editor-and-chief of Elle magazine, who suffered from a stroke when he was 43 that left him completely paralyzed with the exception of his left eye and lid.  Unlike 90% of those with locked-in who pass away within the first four months, Bauby lived a little over a year, long enough to dictate an entire book by blinking his left eye as letters were read to him in order of frequency of use.  He died two days after its French publication.  The book took about 200,000 blinks to write; an average word, about two minutes.  His book is heart-breaking and hopeful and beautiful…and you can imagine how this movie is one I’m dreading seeing, but one I can’t bear to miss.

Oh, it’s been a while!  I think I should cut this hiatus short, if I don’t get too bogged down in Brain & Behavior.  I’m feeling loads better (I can type pretty easily, though writing is still a bitch), mainly just entering the annoying-as-all-get-out stage of the injury.  Just got my stitches out this past Monday, and I have a dainty 1.5-inch scar on my shoulder (the beauty of healing by primary intention).  Thank you so so much for all your kind messages!

I have a series of fun pieces of news to share, which I’ll try to spread out instead of slamming you with an overwhelming megapost.  So I should start with the most joyous and exciting, yes?

Starting in July, JOHN WILL BE A FACULTY MEMBER IN THE CHRISTIANA EMERGENCY DEPARTMENT!!!  He was offered the position at the end of December, but I had to be pretty tight-lipped about it (well…tight-lipped for me, at least) until he crossed the T’s and dotted the I’s of his contract.  We are both thrilled!!  Of all the locations where he interviewed, Christiana was John’s favorite.  It really has it all: a reputation for stellar patient care; access to a diverse patient population and high acuity situations; incredible academic opportunities; inspirational colleagues and mentors…and the list goes on…

And so we’re on to our next adventure: DELAWARE 🙂

I can’t tell you how abundantly happy we are that we can both learn (and work, in John’s case) at institutions that will really help turn us into the physicians we hope to be…AND I’m getting my favorite roommate back!  Living alone has had its fun, bohemian moments, but living together is THE BEST!  I can’t wait to get back to a life of waking up next to my favorite person, having someone else for whom to cook (and who might do the dishes in return), and simply returning to the day-to-day moments, the insignificant (less significant) errands, divisions of labor, study breaks, afternoon capuccis, drop-of-the-hat road trips, hikes, concerts.  (And, God forbid either of us sustains another restrictive injury or illness, it’ll be nice to have someone around to help the other, say, put her hair back in a ponytail…just a “for instance.”)  I can’t wait.

4.5 months!

Pathetic, really…when my level of distraction gets to a point that I need to take the term “bathroom break” quite literally.  I’m not allowed to use the facilities until I make it through another 30 slides.  Feels like I’m on a bad road trip.

I have a four-hour exam tomorrow.  If I can pass after being in a oxycodone + acetaminophen (which is NOT a Non-Steroidal Anti-Inflammatory Drug)-induced coma for the last ten days, I might pee in my pants out of excitement (which would be sad since I’ve been wearing the same pair over and over again…it’s the easiest one to put on one-handed).  How’s that for a “bathroom break.”  I don’t even know what that means…

A nerve block is an incredible thing, and particularly amusing to a group of MS1s when it starts to wear off and the functions of the intrinsic hand muscles return before the extrinsic ones.

Love how cheap Percocet is under my student health insurance.  $8.98 for 90 tablets…on the prescription, the physician specified “90 (9-0)” in order to avoid any confusion.  I’m pretty sure these will have me hibernating for the next month.

I’m so lucky to have a husband who somehow makes a 24-hour trip to Philly the day before leading a Morbidity and Mortality conference in Boston, and who still tells me I’m beautiful even when my face is splotchy with some sort of iodine antiseptic used prior to intubation.  And my friends are the best.  Five days before a major exam, and they’re taking shifts keeping me company, bringing over dinner, and getting my prescriptions filled.

Learn to be left-handed.  So far, I’ve figured out how to write my name without making the “j” and the “e” backwards.  I’m hoping I get up to the kindergarten level of penmanship by the end of the week.

It seems as though I was really tempting fate with my last post.  I didn’t even make it to Spruce Street.  Somehow, between the trolley tracks and the dappled icey patches on 11th, I ended up sprawled on the side the road, my bike about ten yards behind me.  Five gentlemen seemed to appear out of nowhere, scooped me and the spilled contents of my backpack off the ground, and rescued my bike from on-coming traffic.  One of them said that it was a gnarly fall; the others concurred.  Just a little sick that I take pride in this…must have to do with the whole youngest child’s need for attention and recognition.

My first thought was that I just got the wind knocked out of me.  I tried to put my backpack on and get back on the bike, but the right shoulder was not having it.  Fine, I’ll spurge on public transportation and strap the bike to the rack on the front of the bus…but I couldn’t really do anything with the right arm, so I came to the conclusion that lifting the bike might be a bit of an issue.  I grabbed a poor patron of Good Karma Cafe to help me get my bike to my apartment building, and then I called John. 

 Together over the phone, we determined that I didn’t have any nerve injury, no tingling or numbness, and I felt that, were it not for the pain, I could move my right arm in all directions.  So John agreed that I could probably wait it out for a bit.  I had a neighbor come over to help me get my coat off, but we couldn’t slip it over the shoulder due to swelling.  That was my cue.

Everyone in the ED felt pretty confident that I dislocated my shoulder.  They gave me a bunch of percocet and sent me to radiology.  But first, here’s some comic relief: it’s standard protocol in the ED to have women in their childbearing years submit a urine sample in order to rule out pregnancy.  Easy enough, right?  Okay, imagine you’re trying to complete the task, one-handed, and it’s not your right hand.  Now imagine that the damn sealing tape on the cup is so unfathomably strong, you’re reduced to slitting it with your lower teeth before clamping the cup between your feet and unscrewing the cap.  And the door the bathroom sticks…so you’re literally throwing the left side of your body (much to the discomfort of your jostled right shoulder) into the door in an attempt to flee from the bathroom of disgrace, before you finally surrender to knocking for the nurses to let you out.

When the PA returned from radiology, he hesitantly started, “Well, the good news is that you didn’t dislocate your shoulder.”  Pause.  “You have what we call an acute fracture of the proximal humeral head extending to the surgical neck of the humerus with impaction and displacement.  The fracture line extends superiorly.”  Well, I’m no doctor, but I’m pretty sure that means I crushed part of my arm closest to the shoulder. 

So, what does it all mean?

• It’s confirmed, I’m an idiot.  I have no one to blame but myself.  I tried to save $4 in bus fare and ended up spending $75 in copays, and that’s just the beginning.
• I’m sulking a lot because it feels like I can’t do anything: write; type comfortably (many body and hand contortions were attempted in the writing of this post); cook; clean; brush my teeth effectively; take off the shirt I was wearing the day of the accident (I eventually did, but many a tear was shed); perform any physical activity; make it through a lecture without falling into a drug-induced sleep.
• I think showering and putting on deoderant are my greatest challenges; so I expect many of my friends will start to avoid me when the stench gets too bad.
• I’m not 100% decided, but I’m likely having surgery on Monday morning.  I want to heal quickly and correctly.  Since the bones are already displaced and it’s not possible to cast this part of the arm, I think surgery might be my best option.
• I might be taking the MDTI final orally.  Good God that sounds terrifying.
• Finally, although I’ll try to write from time to time, I think I have to take a 6- to 8-week break from blogging.  It saddens me considerably, but I hope you might check back in periodically.  And thanks for sticking with me thus far.

Happy snow days everyone!  Be safe and toasty warm!

I’m biking.  To meditation class, then the library, where West Wing and Planet Earth cannot tempt me.

Taxi drivers of Philadelphia, I implore you to have mercy on the pathetic demonstration of machismo you’ll witness on Spruce Street.  No points for running down a stupidly stubborn med student with wet hair.