anna in med school

Not to be self-deprecating–I truly don’t think I’m a hackjob–but my brain takes a while to absorb this science stuff.  I listen to lectures (often twice), fill composition books with notes, and just keep writing and rewriting and talking out-loud to myself and obliging peers until it starts to sink in.  Needless to say, I’m thrilled if that process reaches completion before our final, let alone before 8am discussion.  Therefore, my contribution to the learning process in discussion is questionable.

But not today.  I might not have been able to ID the all incidences of koilocytosis (the presence of various structural irregularities in squamous epithelial cells) in a Pap smear image, but I could succinctly elucidate the purpose of a speculum.  I suspect that some of my colleagues will not altogether love Repro.

Not that this information is at all helpful now, but I think I’ve picked up a few tricks from hanging out with doctors (probably sounds banal to anyone in clerkships and beyond).  How does one perform a thorough pelvic exam on a morbidly obese woman?  Use a plastic glove, cut off the tip of a finger, and wrap prepared portion around speculum.  Thank you, Tommy.

Regarding Mechanisms of Disease and Therapeutic Interventions, I’m not quite ready to throw in the towel…I have so many more related psychosomatic symptoms to experience!  But I’m also finding some relief from Lisa C’s advice regarding Mod 2: I don’t have to have “it” (study habits, methods by which I learn best, etc.) all figured out.  The beauty of Mod 2 is that we start fresh with every block.  If MDTI doesn’t go as planned, suck it up; Brain and Behavior starts the next day.  So right now I’m going try to wrap my mind around Warfarin-Vitamin K tango…and maybe later revisit my old friend, Ian McEwan:

For this was the point, surely: he would be a better doctor for having read literature.  What deep readings his modified sensibility might make of human suffering, of the self-destructive folly or sheer bad luck that drive men toward ill health!  Birth, death, and frailty in between.  Rise and fall–this was the doctor’s business, and it was literature’s too.  He was thinking of the nineteenth-century novel.  Broad tolerance and the long view, an inconspicously warm heart and cool judgement; his kind of doctor would be alive to the monstrous patterns of fate, and to the vain and comic denial of the inevitable; he would press the enfeebled pulse, hear the expiring breath, feel the fevered hand begin to cool and reflect, in the manner that only literature and religion teach, on the puniness and nobility of mankind.

Atonement

I still have his Saturday sitting on my nightstand, 2/3 read.  That’s practically blasphemy.

–Kevin Bacon’s reaction to the illegality of dancing in Footloose.  Not a concern at PennMed Prom 2011, where there was no lack of dancing.  A few points of interest:

• I woke up on Saturday still in my formal dress.  My eyes were pretty crusty after sleeping with my contacts, and the balls of my feet felt like I had run a marathon in stilettos.  All signs of a successful prom.
• With the exception of possibly the husband–and that’s just personal preference–Erica is, without question, the best date ever.  I don’t know that I’ve ever met anyone with a comparable social IQ, who can meet an onslaught of MS1s while being effortlessly gregarious and charming, and the best damn dancer this side of the Mason-Dixon line.  And her interest in getting to know my classmates actually gave me this fun opportunity to kind of rediscover how I met and got to know each of them, to articulate what I appreciated about the individuals and our relationships.  (Ivor, for example, I sat next to on the housing tour at Penn Preview.  My thoughts at the time: Oh, thank God!  Someone who doesn’t take himself so damn seriously!)  Awkward/Awesome moment: today one of my classmates told me that my husband and I looked so adorable on the dance floor together.  Um, if by husband, you mean that saucy minx in the gold dress (or Sara in the slinky teal number?), then yes, we are quite something… In all seriousness, thanks so much, Erica, for a wonderful visit!

• As I mentioned last week, it was a tough transition back to school.  Therefore, immediately after checking coats, we took the shortest path to the bar.  Me: “So, I’m not sure what liquor you have.  Do you make Manhattans?”  Bartender #1 (of many), deadpan: “We make everything.”  Good answer.
• One of the best parts of prom was meeting the significant others–such a privilege to start to get to know the people who mean so much to new friends and colleagues…or at least put faces to the names I’ve been hearing repeatedly in conversations since August.  If we talked too much about boring med school stuff, please forgive us…my last med prom, I went as the girlfriend of a med student, and I was certainly not as understanding/tolerant of the lack of variety in conversation as the VSOs I met on Friday (belated apologies UVA Med 2008 :/).  Thank you for joining us.
• Joe, a fellow learning team member and one of my favorite people, said that he didn’t recognize me at first.  I’m thrilled that, after five months of glasses and sloppy French braids, I’ve created such low expectations of my presentation that all I need to do to fly under the radar is pop in some contacts and straighten my hair.
• Having missed dessert in lieu of dancing, I might have enjoyed the leftovers of my dinner companions.  Classy, no?  I can’t believe I’m admitting this online.
• Despite the freakin’ freezing weather, a dear friend insisted on walking us home, and then he might have consoled my beloved neighbor after a trying day while I, in true Anna-fashion, proceeded to demonstrate my support by falling asleep on her shoulder.  Eric, you are a better man than I.

Oh man, did anyone read this post all the way through?  Today was a tough reality to which to return, as Bugsy Malone and I noted on parallel treadmills, a vain attempt to work off our alcohol guts.

I will drink at least two glasses of water for every cup of coffee consumed.  I still don’t believe in new year’s resolutions, but if I can’t beat the addiction, at least I can be well-hydrated, sort of.

Also, it appears as though we’re the only school back in classes at Penn.  I am missing the regular library and gym hours, but relishing the stillness on grounds.

What a great name, eh?

Today has not been the best.  But, all things considering, I am just really thankful that I don’t have lungs like some of the ones I handled today in pathology lab.  Liquefactive necrosis, you are one foul piece of work.  Caseous (meaning cheese-like) necrosis is pretty nasty…but the complete lack of lung tissue, the empty space that once contained healthy tissue, resulting from liquefactive necrosis is down-right terrifying. 

I was also reminded of this great video of Hans Rosling from four years ago.  Minutes 2:40-5:05 give you the breakdown.  This November/December, another video of his was circulating around the cyberspace, but I’m partial to this one.  Ted sent it to me as a pick-me-up while I was in the throes of my masters thesis.  I might be rewatching it right now…

How is it that the first time in my life that I wake up with heart burn is the week we’re learning about pulmonary embolisms?  Granted, it wasn’t necessarily on inspirations, and probably a little low for a pulmonary embolism.  And there are no other symptoms.  Whatever.

I am slowly going crazy.  Or I’m just becoming a typical medical student.

So, I didn’t take that many pictures over the break, but this series of my brother and niece on Christmas is pretty priceless.  We Oppenheimers can sleep through anything:

When people discuss the transition between Mod 1 and Mod 2, inevitably one of the first differences cited is that our courses are no longer pass/fail, cut-n-dry.  Understandable.  With the exception of very few (perhaps the best of us), we are a goal-oriented, grade-driven bunch.  Come on, we know the statistics.  They’re certainly not everything–thank God–but our grades and our MCAT scores mattered when applying to school.  Why else would I have obsessed over my post-bac grades in order to counter-balance my 2.0 undergrad science GPA?  (To be fair, I only took the one bio class over the course of my entire undergrad career, which I probably should have failed.  My dad made me take it.  I was trying to prove a point…I don’t remember what the point was, but boy did I show him!  Needless to say, he never made me take another science class again, for fear of permanent damage.)  Why else would I have taken the MCAT three times?  Hmmm…I might not have shared that adventure yet.  Long story short, I am not be the best test-taker, but I know what I want.  The last MCAT I took ten days after receiving the scores of MCAT round 2.  But I digress…

Okay, while I understand why we care about grades, and I appreciate that it is important for us to know how we’ll be evaluated and what is expected of us, I can’t get over it: why do we care so much?  Why has honors become the motivation, the carrot dangling in front of our noses?  I mean, aren’t we adults?  Shouldn’t we be passed this?

And I am 100% guilty.  I shrug my shoulders and try to come off like this change doesn’t make a difference to me, but I’m lying.  There is a variety of motivations to consider here.  There are my peers who know (how they know, I have no idea) that they want to enter into a competitive specialty, and will therefore work beyond the limits of sanity to honor in every subject.  And then there are those who simply don’t want to be embarrassed in comparison…I unfortunately fall, at least in part, into this latter category.  Every time a classmate says something to the effect of, “Well, it’s honors/pass/fail, now people are really going to bring it,” I’m left horrified: “Weren’t they already bringing it before??”

Of course, beneath this unfortunate layer of bullshit, there is good…a lot of good.  We are all motivated by a love of learning, a desire to develop ourselves as students of the medical profession, a hope of becoming great physicians.  If I believed in new year’s resolutions, I would say that I was going to try to, in all sincerity, keep these goals as the keystone in my Mod 2 efforts, and do my best to ignore the honors.  There are some Penn students who already succeed in this regard, like pros.  I have no idea how they obtained this truly remarkable combination of strength of character and work ethic, but I hope I might uncover their secrets.  The alternative is too frightening to consider.

It seems as though I am having a very hard time getting back into my normal life.  It’s been a while, I know.  Vacation was wonderful, chock-full of favorite people (sadly, not everyone), mini-adventures, and good stories.  I want to want to write, but my bed is calling me.  And so, for now, on the topic of stories:

It didn’t matter that the story had begun, because kathakali discovered long ago that the secrets of the Great Stories is that they have no secrets.  The Great Stories are the ones that you have heard and want to hear again.  The ones you can enter anywhere and inhabit comfortably.  They don’t decieve you with thrills and trick endings.  They don’t surprise you with the unforeseen.  They are as familiar as the house you live in.  Or the smell of your lover’s skin.  You know how they end, yet you listen as though you don’t.  In the way that although you know that one day you will die, you live as though you won’t.  In the Great Stories you know who lives, who dies, who finds love, who doesn’t.  And yet you want to know again.  That is their mystery and their magic.

–The God of Small Things by Arundhati Roy

I love this quote.  It’s not really applicable to anything (although, I guess it could be applicable to everything if you stretch it far enough), I just kept thinking about it on the overnight bus back to Philly this morning.  John knows I love it.  I marked this passage in his copy–The God of Small Things makes an excellent holiday gift.  He later incorporated it into our proposal, which I remember surprisingly clearly considering I was still hopped up on percocet after an unexpected trip to the ER.  He kept asking me how long it had been since I had taken a tablet; he wanted to make sure I could give informed consent.  Sweet, ethical kid.

More, better stories tomorrow.  A pig named Celeste and a goat named Ethel might be involved.  And then, of course, on to Mod 2!  Woot!

One night in December 2007, I was studying for my organic chemistry final in the dilapidated library at Goucher (I wouldn’t be surprised if the water-stained carpets were over 50 years old), when I got a phone call from my sister.  “You’ve seen Stranger than Fiction, right?”–not such an unusual conversational habit for Sarah, forgoing the traditional greeting and shooting straight into the reason for contact.  “Remember Maggie Gyllenhaal’s character?  She flunked out of Harvard Law and opened up her own bakery.  I think you should do that.  You know, like what you planned when you were a kid: you wanted to marry me, and we would open up a bakery together.”  Tempting….particularly in the middle of soul-sucking premed finals, very tempting.  And, while we’re on the topic, can I just express how grateful I am that I have a sister who, eight years my senior, always thought it was more cute  than perverted when four-year-old Anna declared regularly that she wanted to marry her first-degree relative.  (Sarah also let our mother dress us up periodically in matching outfits, which I’m sure, when I was four and she was 12, must have looked incredibly cool to a seventh-grader.)

Sass reminds me of this option once a year or so, often when we come together around some holiday and find ourselves hunched over the same mixing bowl, “sampling” the frosting off spatulas, discussing whether or not we’ve added enough booze.  Alas, I do think I’ve found my calling in the medical profession, so Sarah lets me indulge in the fantasy instead by reading about food, preferably books that she’s already owns and is willing to give and/or lend me…which really doesn’t leave out many halfway decent food books.  A few days before Christmas, I emailed to ask if she had a copy of Molly Wizenberg’s A Homemade Life.  “Uh…yeah, I think it’s somewhere buried in my car.  It was disappointing…but you might like it.”  Yes, I am decidedly less discriminating than my sister when it comes to food memoirs…or I just put up with sappy writing better.

Well, it’s definitely no Cooking for Mr. Latte (Sass’s x-mas 2008 gift and arguably the most enjoyable book I’ve read since), but I’ve totally relished the easy-read chapters, curled up in a fleece blanket by the Christmas tree.  A description of Wizenberg’s father:

He could be pouty, of course, and a real huffer-and-puffer.  His favorite weapon was the silent treatment, and he wielded it with impressive skill.  But he had more love, and more passion, and more enthusiasm for pretty much everything than you and me combined.  He loved being a doctor.  He loved Dixieland jazz.  He loved the old Alfa Romeo Spider that sat in the driveway and never ran.  He loved crossword puzzles, Dylan Thomas, and Gene Krupa banging on a drum kit on the stereo upstairs.  He loved omelets and olives; murder mysteries and short stories; and a hideously ugly ceramic wild boar that sat on his bathroom counter.  He loved his children, even while he forgot our birthdays; loved a cold beer on Saturday at noon; loved lamb shanks, smelly cheese, and my mother in high heels; loved mayonnaise, and me.

I like it when stories include physicians as side characters…that and mayonnaise.  John’s Portuguese grandmother made homemade mayonnaise for Christmas.  As she was laying out the ingredients, she asked me in broken English if I was menstruating, because then she would need to shoo me out of the kitchen.  Funny, I very rarely mind discussing my bodily functions, but this barely 5-foot grandma caught me entirely off guard.

The progression of this post entertains me.

The week before finals, I enjoyed a pretty unique kind of study break.  Whereas I normally like to let my brain vegetate to the latest youtube craze (like the Maccabeats, ridiculously adorable children, and ninja cats) or–do I dare admit it?–old Grey’s Anatomy shows on Hulu, the Ob/Gyn Interest Group-sponsored “Watch-A-Birth” was kind of the antithesis of mind-numbing. 

At 6pm on a Sunday, I showed up to the HUP delivery unit in scrubs and with my hospital ID (it’s amazing how much access that thing gives me), and was promptly greeted by a hurried nurse: “You’re here to watch a birth?  Get in room 2.”  I probably could have just followed the piercing screams.  Within twenty minutes, I was rushed into room 10 to see a second birth.  Although both were relatively uneventful vaginal deliveries, the climates in the two rooms were markedly different.  Room 2 made me feel like I was walking into a party: first birth; mothers, sisters, cousins all in the room cheering (for both the new mother and their respective football teams playing that evening); lots and lots of noise.  Room 10 was the mother’s fourth child; no one other than hospital staff and me was in the room; she didn’t make a sound throughout the entire delivery.  I held her hand and felt a little sheepish when, at the end, she turned to me and whispered, “thank you,” the only thing I heard her say in the 15-20 minutes I spent with her.