Physicianesque Vocabulationing and SO MUCH STUDYING!

They say studying medicine is like studying a new language... and SURPRISE! Its true.

I have been studying / in classes from 8am to 11pm or later EVERY DAY for the past two weeks, give or take a day or two off. To entertain / distract myself, I have made this list...

The following are my favorite words we have learned so far (mostly from this 3-week section of studying. Some are anatomical parts, some are diagnostic tests, some are molecules. Feel free to Wikipedia if you want to know what they are - bold ones are most interesting):

* Von-Willibrand Factor * kallekrein * arachidonic acid * calveolae * karyorrhexis * steatosis * liquefactive necrosis * calmodulin * dynein * homonymous * Hageman Factor XII * xeroderma pigmentosa * janus kinase (Jak) * rachischisis / iniencephaly (baby born with no brain / no spinal cord!) *meningomyelocoele * splanchnopleuric * gastrulation (the profs say that gastrulation is the most important part of your life) * sirenomelia * multifidus * dorsalis pedis * genu valgum * Trandellenberg gait * tensor fascia lata * neurulation * Hirschsprung's megacolon * sclerotome * Schwann cell * oligohydramnios * avulsion * trochanteric bursitis * somitomere * tunica albuginea * corpora cavernosum * hyaluronic acid * pyogenic * suppurative * pemphigus vulgaris * Weibel-Palade bodies * kwashiorkor (translates to "the sickness the baby gets when the new baby comes" in the Ga language of Ghana - CLICK ME for more info) * synaptotagmin * hallux (big toe) * Law of Bergonie and Tribondeau * Ortolani's Test *

Leaving out definition makes it much more fun, trust me!

A lot of the people who name things in medicine have weird / difficult to remember names. For example: Mayer-Rokitansky-Kuster-Hauser Syndrome is the official name for women who are born without a uterus. Why?!?!
***NOTE TO DAD - EVER SEE THIS DISEASE?***

So this is me signing out. Its 12:14am and I just got yelled at by security to leave the library. This has been a super duper ultra crazy challenging three weeks - and I have definitely tested how much studying I can take. So with caffeine (from the trifecta of coffee, diet coke, AND tea) in my veins, a sore and pen-stained right hand from transcribing outlines, and eyes glazed from staring at a computer, I am giving up on learning everything and going to sleep.

Good news: the second years said between Thanksgiving and Christmas was the worst part of medical school for them, so if I survive this (AKA pass my exams), then I can do this, and I will get an MD. Yay!

Can't wait for tomorrow - freedom for two whole weeks AND a big birthday / holiday / 1/8th doctor bash at a friends house!

Ouagadougou and Obamacare

Ouagadougou is the capitol of Burkina Faso. I learned that today. So many vowels!

I also tried to decipher my way through the US health care system and US health care reform for my Health Services course (for my MPH). Most interesting for you, my adoring blog fans (AKA my family and closest friends), is the 2010 Patient Protection and Affordable Care Act (AKA PPACA AKA Health Reform Bill AKA Obamacare). So before I attempt to summarize the most interesting and jaw-dropping points, I want to share this simple flow chart depicting how the health care system will change because of this reform:

 

BAM! Now I don't know who to blame for this horrifying flowchart, but it was in the class slides. I hope that clears everything up. 

Anyways here is what I took away from my course about the PPACA:

• The whole Act will be in effect by 2018 (maybe... see the next bullet)
• The individual mandate (everyone has to get insurance by 2014 or they get a big fat fine - with some exceptions) is being challenged in the Supreme Court before June 2012. So watch for news on that!
• Young adults, like me, will be able to remain on their parents health insurance until age 26 - phew!
• Medicaid (insurance for the poor) used to only cover children, pregnant women, and some parents - leaving childless adults insuranceless. After PPACA, Medicaid will cover anyone under 133% of the federal poverty line - this includes 16 million more people!
• Starting in 2014, health insurance companies can no longer exclude ANYONE for a pre-existing condition. 
• States are supposed to make cheaper better non-profit health insurance exchanges, and if they don't the federal government will.
• Health insurance companies have to use 80-85% of premiums on health care for the purchasers.
• Recommended preventative services will be fully covered for everyone!
• 32 million people will get insurance, but even after it is in effect, we will still have 20 million uninsured people here in the US.
• Funding:
• tax on Cadillac (super fancy shmancy expensive) Health Insurance Plans
• increased Medicare Part A tax (pays for hospitalizations for the elderly)
• new fees for pharmaceuticals and medical supply companies
• a tax on indoor tanning - sorry orange folk, its dangerous anyway!

Also, FYI, the majority of people who are currently uninsured (close to 75%) have some type of job, or someone in their family has a job. Self-employed, young adults, and early retirees are commonly uninsured. Also, people who are poor, but not super poor, tend to be uninsured (<300% federal poverty line). And people who are uninsured have overall worse access, worse health care and worse outcomes.

Oh, and Medicare sounds terrible to me. Super terrible. According to my course, Medicare only covers about 45% of health expenses. And there are premiums. And deductibles. And its super confusing to fill in those coverage gaps. Ew.

Another interesting fact: Apparently 20-30% of health care is UNNECESSARY, and does not improve outcomes or patient satisfaction. Most docs are paid through fee-for-service.  This gives doctors the incentive to do more tests or procedures - more fees for more services! Services that you may not need... One of the public health professors says that all doctors should be salaried to stop giving them incentives to waste time and money. I'm pretty sure I agree.

Possibly and or partially because of fee-for-service payments, the US pays the highest price for health care. You'd think we'd be fit as a fiddle, but the US actually has WORSE OUTCOMES than other developed countries. The price is not right.

I tried to be neutral and accurate in this post, but obviously I have my beliefs and I also obviously have little time...so feel free to do your own confusing research and get back to me on mistakes. 

A lot of my info is from my course, which is based around the book Understanding Health Policy: A Clinical Approach by Thomas S. Bodenheimer and Kevin Grumbach. Its an amazing (and super liberal) textbook and worth a read if you are interested in this sort of thing. My professor also got a lot of stats/facts from Kaiser and the IOM.

For more information about the Affordable Care Act --> CLICK ME!!!

(or there is always Wikipedia, which may be less biased, but who knows)

Interesting and Important Stuff of the Week

1. A standardized patient reflects on experiences with medical students - CLICK HERE 
I stole this from the facebook group our med school class has - we are super dorky and share cool articles / ideas with eachother!

Here's a quote from the reflection: "Over the course of three days recently, I had 23 head-to-toe physicals from 23 second-year students at the Georgetown School of Medicine. I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy. Some were certain about the location of my organs, but were stymied by the mechanics of my hospital gown and drape. And a few were so polished and confident that they could be dropped midseason into Grey's Anatomy."

2. Here is a picture of the nerves in the brain of a brainbow mouse. Yep, as in BRAIN + RAINBOW = BRAINBOW!!! (cited in my lecture slides to be from Jean Livet/Lichtman Lab at Harvard University)

I looked up the brainbow mouse, and found these amazing pictures. Art project anyone?
GOOGLE IMAGE SEARCH FOR BRAINBOW MOUSE

The brainbow mouse was used to visualize different neurons in the brain so the brain can be mapped to create a "connectome"(figure out all the connections of all of the neurons in the brain). According to Wikipedia and the web, this technique inserts inducible genes for fluorescence into the mouse embryo, and recombination causes different neurons to express different mixes of colors, causing different hues. I may have gotten that wrong because there was no simple explanation of how it works, but for you science nerds, its technically done by Cre/Lox recombination.

3. Inner Life of the Cell - REALLY COOL VIDEO
This video shows how the cell works. I actually could explain most of the processes occurring in the video and what diseases occur if those processes failed, which is slightly exciting. But check it out, its pretty crazy to think each cell is doing all of these things. I meant to send this out a while ago, so here it is now!

4. What is a leg? I always thought, despite taking anatomy twice prior to medical school, that my leg was anything under my hip... Well I was wrong. My leg is anything under my knee. Between my hip and knee is my thigh. Everything below my hip is actually my lower limb. MIND BLOWN! I have been using the wrong term for something so simple for MY ENTIRE LIFE. Oh the things you learn in medical school...sometimes the simple stuff is just as fascinating as the complicated stuff!

5. Medical school is awesome and cool, as explained above, but it is also super stressful. I am often tired, grumpy, and feel like I don't have time to take care of myself. I am so thankful that the people with me in Boston are able to help me through these frustrations and hard times. I am also thankful for the support and understanding of friends and family outside of Boston, and feel like I could never survive medical school without everyone's help.

Anatomy

So as we continue to delve deeper into the legs of our cadavers, we are delving deeper and deeper into what my second year friend at UF medical school likes to call sweatshop learning. No sunlight, bad conditions, poor nutrition and learning from sunrise to sunset. There is an incredible amount of material that I am expected to learn in ridiculously short periods of time, but hey, at least now I really truly feel like a medical student.

What makes me feel like a medical student, you ask? The main reason: Gross Anatomy!

• I constantly smell like formalin from the lab 
• Tuesdays and Thursdays I run around campus in formalin-sprayed scrubs (yuck)
• I usually have a Netter's Atlas of Anatomy tucked under my arm for studying
• I mutter innervations and blood supplies when walking home from school
• I randomly move my body parts while studying to help remember muscle functions

But also, since you asked...

• I constantly have my iPhone on me to look up random medical facts / keep up with my calendar
• I eat mostly canned and frozen food (hey at least I add spices and sometimes fresh ingredients...)
• I sleep < 6 hours a night (I'm working on it!)
• I am constantly in class, studying, complaining about studying, or thinking that I should be studying
• I think I have every disease we study - even when I have zero symptoms
• On a similar note, I like to pretend I can diagnose people on the street with random diseases (especially Graves' Disease - SEE IMAGE HERE)
• I complain too much (also working on it!)
• I find this: CLICK ME HILARIOUS

It should be easy, here at Tufts. Its Pass/Fail, how hard could it be? Thing is, I can't do Pass/Fail studying. I don't like to study to pass, I want to do well and understand/know the material. I mean, what would my future patients think if they knew I studied to pass!?! I wouldn't like that attitude from my doctor... So despite the fact that my grades absolutely don't matter in any way at all and never will, I study like mad and try to learn everything. And everything is a lot. Good thing I like to learn!

So Thursday we start Physical Diagnosis, and I'll be able to do a real doctory physical exam!!!!! Next time you see me, let me practice on you, because apparently I am supposed to practice on at least 100 people. I am just excited to learn how to actually the cool doctor tools I bought!!!

Also - Thanksgiving break was ABSOLUTELY AMAZING!! I missed my family so so much and had an amazing time in Annapolis. Can't wait for winter break and a real break from studying!

I'm Late I'm Late I'm Late!

Well thats how I always feel. Late. Or behind. Or out of time. It is very stressful to have too much to do and not enough time. But complaining is lame, so here are some exciting things going on:

1.) I finished Med Foundations I - that means no mo molecules! I'm moving up in my medical knowledge to Gross things. Like Gross Anatomy (dissecting human cadavers), which starts tomorrow. I make the first slice at 10:15am. Or sometime around then. I was lucky enough to take Dissections / Gross before so I know the drill (or the scalpel), but it is such a challenging class that I am sure it won't be much of an advantage. I will need to study study study - and keep up with the dissection videos and tutorials so I know what to do in lab. Scary! At Tufts, the dental students dissect the top half of the body first, so the bodies we get are almost completely dissected. They hide the faces from us until we get a new body halfway through, and then we meet our new cadaver and actually get to humanize them by seeing their faces. I don't really like the idea of doing things this way, but I am appreciative in general of having the opportunity to do such an amazing thing again! The human body is so fantastic and interesting, and it is going to be an exciting next few months full of learning, exploration, and really hard exams!

2.) On our last exam, one of the questions was about the disease that was mocked in "Contagion," the Nippa virus (shout out to my Mom, who's obsessed with Contagion!). I can't quite remember the question, but the Nippa virus is apparently a single stranded anti-sense RNA virus with a helical nucleocapsid.

3.) I love my friends. Tonight we went out to dinner for a friend's birthday and on the walk back, the 5 of us sang Disney songs on the streets of Boston. It was amazing.

4.) Keeping in touch is really hard, so forgive me for being awful at it. I do think about my family and friends from Florida / Maryland / everywhere all of the time, but am so scatterbrained and have so little time and am always surrounded by friends that by the time I am ready to call someone it is 11:30 and they are probably in bed. I will continue to work on it, but because I just started Dissections, I can't imagine I'll be any better about phone calls. Email me about your lives and I promise I'll respond!!

5.) Today I sat in on an Ethics discussion about mandating parents of adopted / non-biological children to tell their children about their true background. The children have a right to know their own information, but it ended up being an argument about who's autonomy was more important - the parents' or the childrens'. Very interesting debate.

6.) After my exam on Thursday was "Stache Bash" - a fundraiser / party where the med students competed over Best / Creepiest Mustache. The boys in my class have been growing ridiculous Staches for weeks, and Aren, who came to visit, brought some epics Staches for us to wear. See the photo below! The event was so fun and funny, and everyone had a fabulously hairy time. I also had a lot of fun being touristy with Aren. We did the Freedom Trail, climbed the Bunker Hill Monument, and had a lot of fun hanging out all weekend!

 

Thats all I have for now - sorry for the sporadic posting, but I had a grade that I had to fix!

Changing

So some anonymous person commented on my last post and I decided to dedicate a post to my response to their comment (which didn't really elicit a response but I want to respond so here it is!)

They said:

"From following your posts closely it's pretty clear that you've already undergone a pretty significant transformation as a person. It's interesting to follow. "

I absolutely agree. It is really scary to feel myself changing as the weeks race by. Change is good, but only if I change in a positive way. I know a lot of medical students become depressed, stressed out, disillusioned, and lose their love of caring for others...usually because of the rules, restrictions, and demands placed on them as they move through their medical education

I hope I cling to my curiosity and excitement about the opportunities in medicine and don't get discouraged by the many challenges I face. In my MPH (public health) classes, we learn about the humongous failures occurring at all levels of the medical system, and its terrifying to think about how to handle the failures in my future career.

I want to see my patients as people and not diseases, and as I go through my interviewing class I am definitely doing that, but maybe even too much. I interviewed a patient last Thursday who was diagnosed with cancer for the third time. She cried as she told me she was facing another round of debilitating chemo and radiation with unlikely success. The rest of the day I was emotionally drained from trying to keep myself from breaking down during her interview. I am tearing up just thinking of how much she has been through. I need to find a balance and create appropriate bonds with patients to prevent myself from feeling so drained by their emotional distress. That looks like it will be a big challenge for me for a while, and something I will deliberately work on. I am also pretty sure I want nothing to do with oncology.

I've also realized more and more how impossible it is to please everyone, so I have been using the strategy of being true to myself and my values rather than trying to please the many people that I work with. Of course while respecting their values and personalities and finding compromises where differences occur. The problem is, care is often patient directed now, and I will have to treat patients the way they want to be treated (I am talking medically, not interpersonally) and that will probably frustrate me as I move forward.

I basically have a lot of challenges, and I see them mostly during interviewing, MPH and ethics classes. I am so thankful to Tufts for providing these outlets for me to learn and grow outside of hard science courses, and without these classes I wouldn't have started learning these things about myself until third year.

I am also changing a lot personally. The skills I gain in creating relationships with patients translate into my relationships with everyone, and I find myself applying my interviewing skills outside of class more and more often. I also learn so much about myself so quickly, and have been using what I learn to change my life outside of school (or at least what bit of life I have outside of school anyways).

Article in the times about physician empathy vs. competence: http://www.nytimes.com/2011/11/01/health/views/the-downside-of-doctors-who-feel-your-pain.html?_r=1&nl=health&emc=healthupdateema2

Hectic Days Behind and Ahead

Hello readers,

I don't have much time to blog these days. I definitely feel like I am in medical school now. Last weekend was a huge study weekend and the test yesterday was a big headache. I cried in my seat in the middle of the exam. Don't worry, (1.) its pass fail and (2.) I pulled myself together before the end and finished feeling ok. I also worked out after the exam, which was a HUGE success.

I am really focusing on complaining less, eating healthier, and working out / de-stressing more often. I need to also focus on not overwhelming myself by taking on too much. Class alone is enough to stress me out, but with all of the extra-curricular opportunities its hard to not overdo it. I want to go to a Medical Students for Choice conference, but I doubt that's an option for me (test the following weekend) and the Tufts Ski Trip is also the weekend before an exam, so that is also a no go. So sad. The good news is, for every opportunity I miss, there are two to twenty more available for me to do next time. I have time to do everything I want, I don't need to do it all NOW! Medical school provides us with soooo much to do and so many ways to learn and grow. It is so amazing and enriching and wonderful, but also stressful and hectic!

Today my roomie made yummy squash and chicken curry and amaretto chocolate chip cookies. She invited over some friends and we all talked, watched Life (so good!) and discussed our Medical Ethics course (autonomy, beneficence, non-malefecence, and justice are the main points - we also discussed utilitarianism - do the most good, and Kant / Deontology - be moral as well as Medical Genetics and random other topics). Its all super interesting!

Since my last post, I went sailing on the Charles River (sooo pretty!), enjoyed being outdoors in the fall, went to a med school stoplight party, played frisbee on the commons, toured around with Sloane (I love visitors - especially legendary ones!), went to a festival and brunch with my local awesome uncle, and did random other fun and exciting things. I have a lot of fun, but usually there is this nagging urge to go to the library to study that is hanging over my head during my fun times. It is hard to forget how much I have to do all the time, and I try really hard to let myself take breaks and forget about medical school for a while.

Minor setbacks - but don't worry - I still prefer med school to other options (AKA a job, normal grad school, unemployment, and worst of all law school) and am so glad I am here!

I wanted to write last week about interviewing. I had a moment where I was really able to visualize myself as a doctor and it was a scary thing to visualize. SOOOooooo much is expected from us, and it is terrifying to have so much impact on peoples' lives!! The feelings I had in that moment are long gone (replaced with memorized fat synthesis pathways or something similar or lost on the shelves of the library somewhere). Oh well, that feeling be back I'm sure!

Yom Kip with Levine and More!

Hey blog readers! Sorry its been so long, things have been crazy. I think we are trying to really enjoy the last bits of warmth Boston has to offer. This weekend is beautiful and then I am pretty sure it won't break past the 70s for the rest of the year. Sigh.

So yesterday LEVINE CAME TO VISIT! Yayyy! I love when friends visit because thats when I get to actually explore Boston (hint hint, COME VISIT ME PEOPLE!). We walked around Fenway and Faneuil and then drove north for services and Break-the-Fast at his uncle's house! Levine's grandfather and uncle run "Larry Levine's Kosher Market," in Peabody (which is pronounced "Pea-B'dy" which I find super strange and awkward) so the food at the Break-the-Fast was AMAZING! I had so much fun mingling with the Levines and friends and ate tons and tons of delicious Jewish classics. Multiply the Levine we all know by 20 and that was what the experience was like! It was a good time, and I was so glad to be around such a sweet and welcoming family for the holiday, because I missed my family so much! They sent me home with tons of leftovers and tips on how to survive Mass in the winter!

www.levineskoshermkt.com

What else has been going on? Hmmm... They weren't kidding when they said time flies in medical school. I don't know where time has gone lately. I just study and wander around Boston with my classmates and **POOF** its October! There is always so much going on, its hard to stay inside and study all the time, so this week I kind of haven't been the best student.... BUUUTTT tomorrow is going to be my catch-up day - 12 hours of library! It is so sad because there are so so so many things I want to do and I just can't possibly fit them all into my schedule. I have also been attempting to work out 3x a week so I don't gain a bajillion pounds from all the free food and potlucks. Too much to do, not enough time...sigh. But its way better than having nothing to do, so I really shouldn't complain!

So here are some highlights from the past few weeks:

• writing a group paper on creating a coalition to prevent smoking during pregnancyfor my MPH class (my group rocked, and we had some amazing ideas)
• studying fat in Biochemistry (ugh)
• Passed both Genetics and Cell Biology (two classes down, a lot to go!)
• learning about diarrheal diseases in Molecular Biology (yuck)
• losing my ability to trust any statistic in Epidemiology (its so easy to make study results sound more significant than they really are)
• started interviewing at a hospital in my white coat (I look so official!)
• apple picking for Rosh Hashanah with TUSM Hillel and baking tons of apple pastries (pie, crisp, etc.)
• Rosh Hashanah potluck (I made my mom's Apple cake! Yum!!)
• saw Contagion (you ALL have to see it!)

So now I'm off to the Commons to enjoy the sun! Later!

VAMPIRES DO EXIST - Science can explain ANYTHING!

We learned about vampires and how bruises work and human molecule rainbows in biochemistry today. I love this class.

1. VAMPIRES:

Lets start at the beginning. Humans have blood that provides oxygen to their cells so they can function. The blood has a special part that carries the oxygen, called a heme group. The heme group is composed of a porphyrin ring and an iron molecule (Fe). A picture of the home group is shown to the left!

Now for the vampires!!! When making a heme gets messed up in the body, it results in a porphyria. There is a specific type of porphyria called "Porphyria Cutanea Tarda" that is caused by the deficiency of an enzyme that builds heme (its called uroporphyrinogen III decarboxylase FYI). This disease is thought to have lead to the myth of vampires.

Porphyria Cutanea Tarda (PCT) causes a number of symptoms. Lets go through them, shall we?
(1) Fluorescent White Teeth: Uroporphyrin, which builds up because of the enzyme deficiency, is actually fluorescent, and causes bright white teeth. The teeth (and fingernails) may also turn red from a different molecule that builds up because of this enzyme deficiency.
(2)Fear of light: The build up of the partially formed heme groups causes "skin photosensitivity" or blistering and skin damage when exposed to sunlight.
(3) Drinking blood: Thats right, one of the cures for PCT is blood. Nowadays, the blood is infused, but back in the day, these people may have drank blood, because it would tell the cells to stop making the intermediates that damage their bodies.
(4) Garlic: it is believed that garlic may contain a compound that makes porphyria worse.
(5) Pale skin: porphyria causes anemia, or low blood count. This makes people pale!

Now I did some research after class and apparently the guy who came up with this theory (David Dolphin) was wrong. Drinking blood wouldn't help the disorder, garlic does not make porphyria worse, and people with porphyria don't crave blood and wouldn't know to drink it because they probably didn't know they had the disease. But its cool to think about, and was fun to learn about in class!!!

2. Bruises and colorful breakdowns
When you get a bruise, they turn all sorts of funky colors. Here is why:
First they turn red from the damaged heme from a broken blood vessel under the skin.
Then bruises turn green from the billiverdin as the heme breaks down.
Next it turns yellow from billirubin, and stays yellow for a while until the billirubin can be sent to the liver to be broken down completely.

Heme breakdown also produces purple (porphobillinogen), brown (sterocobillin, which causes the color of feces), more yellows (urobillin in urine). Its a colorful process aparently!

(also, people like to guess what disease famous people / mythological creatures have - we have so far learned that Abe Lincoln may have had Marfan's Syndrome, and that porphyria could potentially explain werewolves too. And crazy ole King George probably had a Acute Intermittent Porphyria because his urine was purple and he was crazy - both symptoms of that type of porphyria)

LIFE!

Finally an update on my life rather than something random. This is going to be a long post...

So this is a good snapshot of the last two weeks: 48 lectures, learning what a double line means in a pedigree, figuring out what my dad does for a living, getting a very white coat, and interviewing patients...about sex...


So the past two weeks we have been studying glycolytic pathways in Biochemistry, fertility and infertility in Cell Biology (my dad's kind of medicine!), inbreeding, ethics, genomic medicine, and risk for genetic diseases in Genetics (a double line on a pedigree means consanguinity - relatives having children together), and bone, connective tissue, and epithelia in Tissue Biology. Lots to learn in just two weeks. But its over, and I just recieved my third syllabus for the next test. This one's pretty hefty, but we have 3 weeks to get through it so I am feeling confident. We started two new courses - Molecular Biology and Immunology. Fun fun!

Last weekend my parents came to town for the White Coat Ceremony! Saturday night they took me and my neighbor Brian (who we adopted) out for a super shnazzy dinner at Taranta - a Peruvian Italian restaursant - YUM! The next morning we rolled into a really fancy theater for the ceremony, which was a lot like graduation, but instead of a diploma, we got short white coats. Luckily for me, Dr. Monaco, president of Tufts University (and coincidentally an M.D.), cloaked me! He's a Tufts-lebrity! Cloaking is done by faculty of the school to represent their belief that we will successfully carry on the traditions of medicine. Very exciting. We also heard an AMAZING speech from Dr. Amy Ship about the importance of humanism in medicine. To sum her up, we should fill our white coat pockets with useful tools - attention, curiosity, and compassion. She absolutely inspiring and made me feel like medicine was the right choice.

The ceremony was followed by a fancy lunch provided by the Tufts Medical Alumni Association. I got to spend time with my parents and uncle, and got to meet my classmate's parents which was really fun and interesting. You can learn a lot from someone's family! My parents also got to see some old friends from their time in medical school, which was surreal. One of my associate Deans still had a recipe that my mom gave her in the 80s! After the ceremony, Mom and Dad took me shopping with help from uncle David and restocked my kitchen!! It was a fantastic weekend and I was sad to see my parents go.

I feel the need to note my annoyance that I am going to have to wear white coats for the rest of my life. As some of my friends from Hillel@UCF know, I really despise wearing white. I guess I need to get used to it...sigh.

Below is a picture of me in my white coat with my parents!

There is no way its going to stay this white...

I am done interviewing at the residence for the elderly and am switching over to interviewing at a hospital next week. In my review, my interviewing group leader told me that I am the best at empathizing with my interviewees and creating quick bonds with them, but that I need to work on my confidence and asking questions in a more organized fashion.

I went back to Sharewood last Tuesday and learned about Case Management and enrolling people in MassHealth (insurance). I also got shot-trained, so now I can give intramuscular flu shots and vaccines. I practiced in an orange and then was certified by giving a shot to a very brave friend. I am now a useful member of the medical community. Who knows if I'll use my new skill, but I figured it would be useful!!

This past weekend I mostly just studied. The good news is that I love everyone in my class so studying can sometimes be really fun. My friend Kate and I put on a puppet show with my socks, my friend Wendy made squirell and unicorn origami, and Kostas brought us all PB&Js. Not bad for a study weekend. Also, my Annapolis buddy Emily came to town for a conference and we meandered through North Boston for the afternoon. We had beers at Beantown pub (cold Sam Adams in front of a cold Sam Adams), tried the original Boston Cream Pie at the Omni Parker House (SO. GOOD.), ran into Jeff Bridges and Ryan Renolds on the set of RIPD, ate in Little Italy (I've been doing that a lot!) and caught up on each-others lives.  I miss all of my friends all over the country and need to be better about staying in touch!

After the exam, my roommate prepared an amazing meal for twenty of our friends. Chicken marsala, pastitsio (pasta with meat sauce and a cheesy mousse-like sauce on top), and spicy raspberry chocolate tarte! Soooo delicious, especially after such a draining weekend and exam! Then we went out to a bar called Coogans to dance and celebrate the completion of test two!

I have been having a great time in medical school, but I am definitely tired a lot and there is always so much going on all the time. I am taking it easy tonight and getting back to the books tomorrow night. I needed the break. My hand was cramping from all of the typing and writing down notes and drawing pathways. I haven't even been doodling! Gasp!

Not-So-Standard Patients!

I apparently never posted this? I wrote it a long time ago and just realized I never posted it. Sorry! Backtrack a few weeks....

Life update: lots of studying. Also, ECS (eat, class, study) is more like eat, class, lunch meeting, class/interviewing/MPH class/study/HW, study, eat, study, nap, repeat. Too complicated...so from now on, ECS means all of those things. I also cook once a week, go to C-Mart (I'll devote a post to C-Mart later, be excited), run errands, and started a yoga class on Thursdays (also deserves it's own post).

My lunch meetings are a result of joining all of the school clubs and interest groups. This week I had a Family Medicine Interest Group lunch and a MERC (Medical Education Representative Committee) meeting. Within MERC, I am the class representative for Physical Diagnosis, which hasn't started yet. But I still go to the meetings and discuss how to improve classes.

As always, lots going on. I am attempting to be brief but I always have so much to tell you!!! I have 3 things to discuss:

1.) FIRST TEST ON MONDAY!!! Freak out!!! No, don't freak out, because it's Pass/Fail, so I can get a 65% and still become an MD. This is slightly concerning to the patient in me, but to me its a huge relief as a med student. Its super helpful right now because my life is super crazy and I am in Gainesville and enjoying spending time with the family too much to study...oops. Good thing I studied so much after class every day. Hopefully the hard work throughout the block will help me make it through this exam despite a semi-slacker weekend.

2.) Standardized Patient Interviews! So for interviewing class this week, we went to the Sim Lab (Simulation Lab) where we had our first SP experience. Actors come in and pretend they are patients with problems. We will be using SPs for Interviewing and Physical Diagnosis practice before attempting on real patients. SP experiences are half fake and half real, because you are (usually, not this time though) being graded for your professionalism and competency, but the actors aren't really sick. It's almost a game because the point is to ask the right questions and do the right tests to figure out the problem and find a solution for the patient. Weird. But again, this experience was just for practice. So we were told to get the CC and the HPI for the patient. CC = Cheif Complaint. HPI = History of Present Illness. Gotta keep up with the lingo!

The HPI involves asking a series of questions about the CC. The mnemonic to remember when asking questions about a new complaint is FAR COLDER, which I could explain, but 1) I can't remember all of them, and 2) its basically just questions like what, where, when, how, why, for how long, etc. But in (standardized) reality, when you just ask "Why did you come in today?" let the patient talk, then say "Tell me more about that..." the (standardized) patient will tell you most of the acronym up front. Then I can just get more info as needed without pestering them with tons of questions!!

I LOVED working with the SPs and here is a sample of the fake patients we got:

• An anxious law student with a mother with Alzheimers who isn't sleeping well
• An elderly woman with follow up for hip fracture who's husband just died. 
• A woman who is having blurry vision and has to urinate frequently.
• An 80 yr old man with a new sexual partner who wants more information on safe sex

Our interviewing group messed up a lot.  But we basically got a sample of the different types of patients we may see, and will have lessons on how to handle each type (mental health, dying, crying, sexual health, bad habits, etc.).

• Blurry vision and frequent urination (do I talk about pee too much?) is probably indicative of diabetes...
• Don't forget to ask a patient's name, and always wash your hands when you walk in the room.
• Don't try to get stubborn people to change unless they are somewhat willing to!
• With mental health issues, there are a lot more mnemonics (SIGECAPS for general mental health issues, DIGFAST for mania)

Poha Chivda and the Citric Acid Cycle!!!

Poha Chivda is a delicious Indian snack made of rice flakes, peanuts, salt, sugar, chiles, and CITRIC ACID (see recipe: http://kimberliskitchen.blogspot.com/2011/03/beer-and-poha-chiwda.html)

Picture cred to the blog I linked to above!

I am currently studying at Nami's adorable studio in the Back Bay, and I'm eating Poha Chivda (Nami calls it Ponwa Chevdra, but google says its Poha Chivda...?), and thus Citric Acid, while studying the Citric Acid cycle (part of the process that breaks down glucose into energy).

Poha Chivda is delicious - spicy (chiles), sweet (sugar), sour (Citric Acid), salty, nutty (peanuts) - what more could you ask for?

Just wanted to share!

Pathways, Pictures, Dinosaur Bones, and Mutant Sperm!

I don't have time anymore, so the blogging is declining. Med school is real now, and we have class or activities to do eight to six then I study or do more activities until midnight every night...ack. They went easy on us for the first exam I guess.

So instead of a huge blog rant, here are cool lecture pictures!!

1.) Pathways: For reference, this is what I learned in two weeks in Biochemistry, which accounts for only 1/4 of my classes. We have a test Monday on everything in this picture and much more. Plus the other 3 classes. Yay. We call these Pathways. But to me they are Pain-in-the-buttWays. This shows glycolysis (breakdown of glucose for energy), different ways other molecules can enter glycolysis, glycogenesis (synthesis of storage form of glucose), glycogenolysis (breakdown of storage glucose for energy), gluconeogenesis (creation of new glucose molecules for energy), and other related pathways. We also need to know inhibition / activation of all of these things. My favorite inhibition is the phosphorylation of phosphorylase phosphatase in order to inhibit phosphorylase. If you get that on the first read, major props.

2.) Dinosaur Haversian Systems  - Cool picture from Histology, which we call Tissue and Organ Biology (TOB) - the study of tissue / organ structures. In compact bones (think skeletons), there are structures called "Haversian Systems" that keep the bone strong and allow blood vessels to run through the thick dense bone tissues. Below is a picture of dinosaur Haversian systems. The color changes are based on which systems are  newer (darker) and which are lighter (older). The white spaces indicate where blood vessels run through. This looks the same in humans as it does in dinosaurs, and I thought it was a really cool picture (that I may paint sometime soon hopefully - maybe Monday**). Reminds me of abstract art. Somebody find the artist I am thinking of and comment, I don't have time.

3.) Mutant Sperm: We are studying infertility / menstruation / ovulation in Cell Biology, and were shown this crazy picture of defective / mutant sperm (which usually causes infertility or seriously messed up embryos). I thought it was cool, so I decided to share.

 

I hope you enjoyed my quick blog post. I promise to update on my life when I have time.

**I tend to put everything off until after the test (such as laundry and leisure and exercise). Then after the test, I am too tired to do anything and end up being a vegetable in bed all day. This Monday (test two) I plan on watching Glee, painting, cooking, doing laundry, cleaning my room, and doing MPH hw. The likelihood that I will do anything other than watch Glee is very low...

Interpretations and Muffled Noises

After the chaos of post-test celebrations, things returned to normal - eat, class, study, sleep. I am trying to add in some fun and some exercise for mental health, but its proving difficult. I did work out yesterday, though!!

So anyways, on Wednesday, I had my first Problem Based Learning (PBL). We had an introduction lecture on PBL last week that was sooo awesome! The professor used every type of teaching method possible in one hour, and had a glowing fluorescent disco stick that he used to encourage us during the lesson. He was also wearing a bowtie and a cowboy hat when we walked in. He had my classmates dress in different hats and write things on the board and shout out answers and more. It was my favorite lecture so far, and was a great way to lead into PBL

So PBL is basically a small group (5 first year students and one 4th year facilitator) where we slowly make our way through a clinical case and stop every few lines to discuss:

1. What we know (from the case)
2. What we want to know (questions we want answered based on what we know)
3. Problem List (known medical problems in the case)
4. Hypothesis (guesses of what the medical problem is)
5. Learning Quesitons (questions to look up to make solving the case easier)

So from a case on a 6 year old male presenting with fatigue, bleeding gums, and a sore throat our hypotheses were scurvy, overbrushing, a viral or bacterial infection, a clotting / blood disease, and an autoimmune disease. We later found out that he had petechiae all over his body, and we aren't allowed to look up what it is until next week. It is hard not to skip ahead to find out whats wrong with our poor patient, but it is cool to come up with different ideas, questions, and thoughts based on very few details and then more and more as we go along.

Throughout PBL we will have 6 cases. We can go through them as slowly or quickly as we want, and every week we each have to chose one or two Learning Questions to present in the next session. The facilitator just keeps us on track and encourages more questioning and thoughts. And the process is not about finding the exact thing that is wrong with the patient, but to come up with creative differential diagnoses and questions that we should ask when presented with certain things. I love PBL, and can't wait to find out what petechiae are. I'll keep you posted!

On Thursday I had interviewing yet again, back at the home for the elderly. This week we worked with interpreters, and for the first time had to do AN ENTIRE MEDICAL INTERVIEW. Which includes:

Chief Complaint (CC)
History of Present Illness (HPI) - What, Where, When, How long, Why
Past Medical History (PMH) - hospitalizations, surgeries, chronic illnesses, OB/GYN info, prevention
Social History (SH) - home, work, sex, drugs, smoking, alcohol, seatbelts, guns, violence
Family History (FH) - family members with diseases

Its a lot to remember, especially when you are trying to listen to the patient's answers and store the information to put in the chart later! ACK!

But using an interpreter was cool! We were instructed to set up with the interpreter next to us and the patient in front of us both. We were told to look only at the patient, and speak directly to the patient despite having to use the interpreter. We were also told to never speak only to the interviewer, and to assume that the patient can completely understand us (no side convos!). It was hard to listen to one person while staring at another, but I think it really made the person I was interviewing more comfortable. She was an adorable 72 year old Chinese woman who gave us all grapes and had very few health problems.

I did not study enough this week and am 8 lectures behind. Thats 16 hours of work. EESH!!!

PS: I got my stethoscope!! Its purple!!! I can't hear anything I'm supposed to yet, just a bunch of muffled noises...but its pretty cool and I can at least look official now despite the fact that I still know nothing of significance. Other than some really weird rare diseases and a lot about Trisomy 21 (Down Syndrome).

Annnd an awesome package from my old coworkers at AACPS!! Thank you so so much to those of you that contributed, I absolutely LOVED it!!

The First Test

After a long weekend of family time and attempted studying in Gainesville, an anxiety-ridden delayed flight to NYC on 9/11 and a race to catch my connecting plane to Boston, I made it back at about 12:30am to take some practice tests. I got to bed around 2am, and woke up at 7 for some extra study time.

The exam started at 8:45. My roommate's pre-test ritual is to play opera music, so we jammed out and got excited. She apparently loves test days. I think shes crazy! She got all dressed up, so we walked to class together, her in her adorable outfit... and me in a sweatshirt and yoga pants. Most people looked less frumpy than I did, but I was comfortable so whatever.

My assigned seat was luckily near where I normally sit sometimes, so I took my seat and we began. My roommate, I am proud to say, was the first to finish! I actually got out of there pretty fast, too. I didn't check my answers - I was too tired and second guessing usually just messes you up in the end. Then I went home and took a two hour nap, which I will be adding hours to as soon as I am done eating lunch.

I am pretty sure I passed, but I got a little annoyed at some of the genetics questions so I may not have passed the genetics section. Either way, the questions were fairly reasonable considering the material, and I am DEFINITELY changing my study plan because I was overdoing it before.

Most of my classmates are at "The Tam,"which is a bar thing near my school where people go after exams for some drinks. I am too tired to go, so I will have to ask them how that Tufts tradition is. Tonight we are celebrating the end of the exam at "Sissy K's" with karaoke and dancing. The second years planned the festivities for us (they are so sweet!) Sounds fun and hopefully I will be less tired by then and ready to party!

Patients Acting Standard

First off - TEST MONDAY!!!!!!!

So for interviewing class this week, we went to the Sim Lab (Simulation Lab) where we had our first Standardized Patient (SP) experience. Actors come in and pretend they are patients with problems. We will be using SPs for Interviewing and Physical Diagnosis practice before attempting on real patients. SP experiences are half fake and half real, because you are (usually, not this time though) being graded for your professionalism and competency, but the actors aren't really sick. It's almost a game because the point is to ask the right questions and do the right tests to figure out the problem and find a solution for the patient. Weird. But again, this experience was just for practice. So we were told to get the CC and the HPI for the patient. CC = Cheif Complaint. HPI = History of Present Illness. Gotta keep up with the lingo!


The HPI involves asking a series of questions about the CC. The mnemonic to remember when asking questions about a new complaint is FAR COLDER, which I could explain, but 1) I can't remember all of the questions, and 2) its basically just questions like what, where, when, how, why, for how long, etc.

But in (standardized) reality, when you just ask "Why did you come in today?" let the patient talk, then say "Tell me more about that..." the (standardized) patient will tell you most of the acronym up front. Then I can just get more info as needed without pestering them with tons of questions!!

I LOVED working with the SPs and here is a sample of the fake patients we got:

• An anxious law student with a mother with Alzheimers who isn't sleeping well
• An elderly woman with follow up for hip fracture who's husband just died. 
• A woman who is having blurry vision and has to urinate frequently.
• An 80 yr old man with a new sexual partner who wants more information on safe sex

Our interviewing group messed up a lot.  But we  got a sample of the different types of patients we may see, and will have lessons on how to handle each type (mental health, dying, crying, sexual health, bad habits, etc.). Also, all of the Boston schools share SPs, and they are super good actors. The anxious guy was so convincing. I love when they break character at the end and give feedback as themselves and you see how well they were acting like the patient! So here are a few things I learned:

• Blurry vision and frequent urination (do I talk about pee too much?) is probably indicative of diabetes...
• Don't forget to ask a patient's name, and always wash your hands when you walk in the room.
• Don't try to get stubborn people to change unless they are somewhat willing to!
  
• With mental health issues, there are a lot more mnemonics (SIGECAPS for general mental health issues, DIGFAST for mania)

I had the anxious patient and the diabetic for my two interviews (each 15 minutes long btw). I got great feedback - I apparently ask a lot of "multiple questions" Like "What is the pain like? Is it sharp or dull?" I should only ask one at a time, because multiple questions stress out the patients and they forget parts of the question(s).  I am great at creating rapport with the patients, and am a great active listener. I sometimes lose track of the point of the interview, but its ok because its usually to chat with the patient about their interests.

We didn't have any solutions for the problems because we haven't been trained on what to say / advise in these situations (yet), so the interviews were slightly awkward because we just asked a lot of questions and then didn't give advice. But I loved the experience and although in the future my experiences will be tested (aka way more stressful), I like working with the standardized patients!

I wanted this post to be way more entertaining, but I'm tired and don't have the energy to go back and make it clever, so it will have to do. Sorry!

Pee Drinkers

If that title doesn't catch your eye, nothing will... This week is going to look a lot like eat, class, study, eat, class, study, meeting, class, study, eat, sleep (instead of GTL, the med school routine seems to be ECS - eat, class, study although some of my cooler classmates do go to the gym every day!). So instead of writing about class, I will tell you the weirdest / most interesting thing I learned, and then I will update you on cool things as they happen. No more day by day reports, because its going to look like ECS and thats just super boring.

So last week we were discussing birth defects in Genetics and got to talking about sequences. A sequence is a disorder that is caused by an initial problem that then causes other mechanical problems during the course of a fetus's growth / development. Like a small chin will cause a tongue that is too far back and that will cause a cleft palate, etc, etc, etc (aka Pierre-Robin Sequence).

But more interestingly, Potter's Sequence (also - gotta love the name even though the outcome is pretty sad) is when a developing fetus's kidneys don't work properly. Because of the kidney problems, these babies don't urinate enough, (and here's the craziest part) so they don't produce enough amniotic fluid. That's right, amniotic fluid is mostly FETUS PEE! It gets crazier. Because there is too little fluid, the baby isn't protected and becomes smushed (flat face, flat ears, clubbed hand) and the baby doesn't swallow / breathe in enough fluid so their lungs don't develop properly. Thats right, not only do we float around in pee for 9 months, we also DRINK AND BREATHE IT IN to develop our lungs and help with our gastrointestinal tract! I had no idea! I don't know what I thought amniotic fluid was, but I wasn't about to guess that it was part pee! Maybe you won't be as surprised...but it sure is interesting!

I am sad to report that Potters babies don't usually survive. Very sad stuff... I wish my fascination was with something happier.


But anyways, now you know - everyone was at some point a Pee Drinker. And you should be thankful that you drank / inhaled your pee successfully!

So you just learned 2 of the ~80 diseases that were covered in the last two weeks of medical school (I made a list!).

Not to mention those diseases were just quickly touched on while discussing cell components, transcription (DNA --> RNA), translation (RNA --> protein), protein structure, protein-DNA interactions, genetic diseases (Mendelian, non-Mendelian), genetic testing, prenatal screening, birth defects, and more.

But guess what - I FINALLY CAUGHT UP WITH LECTURES! Woot!!

The Very Complicated Joke

Thursday was pretty standard. Class in the morning followed by interviewing in the afternoon. The tenants we interviewed were INCREDIBLE and had amazing stories. Can't really say more than that, but I loved hearing their stories and could have listened to them all day. A lot of people went out for Tapas, but I stayed in to rest my foot and got a ton of studying done. I also met more neighbors - the Dental Students have finally arrived! There is a D14 who lives on my floor and he plays piano and mixes beats. Hurray for more friends!

Friday I had morning classes, then studied in the afternoon. That night I went to Hillel for a rooftop happy hour. We ate sushi, drank wine and beer, and played Jewish geography (what Jews do you know - oh I know them too!). As dorky Jewish medical students, we managed to mix class topics into socializing. When discussing how Judaism passes on through the mother, a classmate said "Must be a mitochondrial gene!" (***see the end of the post for an explanation if you don't get it!). The view from the rooftop was incredible. Boston is such a beautiful city, and watching the sun set from a rooftop with a bunch of my friends was a great and relaxing way to end the week!

I decided to give myself a day off on Saturday so I bummed around my apartment in the morning and then went to lunch with a friend from HS who is in her second year at Harvard Law. I took a nap in the afternoon, had a great phone convo with my mom, and then went to Wendy, Audra, and Becky's (WAB's) house for a potluck and a party. I made Trader Joes cornbread (always a good idea - thanks Mom!) and pigged out on the delicious food that everyone brought - YUM! There are going to be weekly potlucks and I'm excited to be friends with people who like food as much as I do!

Finally a short post!

***Explanation of the mitochondrial gene comment: I tried to explain this as simply as possible, but it was actually really difficult to do. I made it as basic as possible, don't be offended I wanted to make sure anyone could understand. Skip to the last point if you understand how babies are made and know how cells work...

1. More religious Jews only consider a person Jewish if their mother was Jewish.
2. Sperm and eggs are cells that mix together into one cell (zygote), and then that cell divides a lot and eventually becomes an embryo, then a fetus, then a baby. (pretty simple stuff, but again trying to cover all bases)
3. Cells have nuclei which hold the genes that are like the architects that plan how you will turn out. They also have other cell components which are like the construction team that puts everything together.
4. Mitochondria are a type of cell component (construction team) that have a little bit of their own genes (architects). They make energy for the cell and their genes tell them how.
5. The egg is a lot bigger than the sperm, so the sperm are mostly made up of nuclei, and the egg has a nuclei and a lot of other cell components, so when they mix together, the egg gives the zygote all of it's mitochondria. So the genes in the mitochondria only come from the mother, but the genes in the nuclei are a mix of mom and dad.

Soooooo...the joke is saying that because Judaism passes only through the mother, it must be a mitochondrial gene because those are the ones that only pass through the mom. 

Here is some more info from Wikipedia - Click me!

And here is a simpler explanation, skip down to "What is a mitochondrial disease?" - Better Source than Wikipedia - Click me!

Painful Learning and RICE

So Sunday was great, and Monday was great, and then Monday ended...and things have been a little less great, but I am trying to complain less in my life, so I will just say that things have been more challenging, which isn't a bad thing, just different!

I woke up Tuesday with a headache and on the walk to class noticed my left ankle was hurting when I stepped down on that foot. It got worse throughout the day, and since then it has maintained a constant state of dull pain when I walk or move it. Not very fun. My Dr. Mom told me that its sprained and I don't need to go to the other, less biased doctors. Hopefully she's right, and luckily, my ankle pain is a learning opportunity. So my treatment is RICE. No not the delicious white part of sushi, but...

Rest - Ice - Compression -Elevation

...RICE! So I have been RICE-ing my foot and trying not to walk much. Small problem - I live in a city, and my feet are my main form of transportation. I have only been walking from home to school (<2 blocks) and from the first floor of school to the library and back between classes and events, but even that is too much and by the end of the day my ankle is in bad shape. Ouch!

I have also had a hard time studying lately (lots of distractions and things to think about), but managed to put in a good number of hours and am only 3 classes behind as of this evening, which is pretty good considering one days worth of materials is about 3 - 4 classes, and each class takes about 2 hours to go back over. Also, based on classmates questions during study sessions, I am actually absorbing information!!! Yay!

BACKTRACK: So Monday we had our first Medical Ethics class. Luckily I was sitting next to my Philosophy Minor / genius friend Tim who helped me follow along, but all I learned during the first half was that medicine is exclusive and I need to join the club. Oh and that "our competitors" AKA chiropractors and naturopaths are fun to laugh at and that I am supposed to hate lawyers. I am not sure if my professor was trying to make a point or if he was serious, so I will reserve judgemnt. The second half was much better and I learned about Tuskegee, Mengele and other unethical studies, and we discussed some hypothetical situations (ex: woman with HIV doesn't want to tell the father of her child why the child needs medications) and how to potentially go about them. I also skipped a class to get a cold Sam Adams in front of a cold Sam Adams with Tim (Beantown Pub is in front of Sam Adam's grave) and watched the lecture I missed online - pretty awesome! But I still think I'll go to class...most of the time anyways.

Monday night my weekend guest departed and my fabulous and talented roommate cooked dinner for me and 10 of our friends - peppadew's stuffed with goat cheese, a caprese salad with a twist (tomatoes, basil, mozerella, balsamic, watermelon, and cilantro) and chicken tikka masala. SO. GOOD. After the feast, we played some games and Nami and I danced to Kesha / Katy Perry!

Tuesday is my long day, so I went to morning classes, went home to rest my foot during lunch, and then went to my MPH evening class. We had to take the Myer's Briggs again - now I am an E-N/S-F-J, (extrovert, equally intuitive/sensing, feeling, and judging). If you don't know what it is, here is a link to take the test, and from there you can find info (take it first though, and tell me what you got!!).

Myers Briggs Test - Click Me!

We also discussed techniques for working in teams while brainstorming solutions to obesity and had a guest lecturer speak about the "One Health" concept - how veterinary doctors, medical doctors, and environmental scientists should work together to solve public health issues.

Today I had class, studied, and then went to a Nutrition and Motivational Interviewing Training put on by TONE (Tufts Outreach for Nutrition Education) so that I can go out and discuss nutrition in the community.

Again I feel like it should be Friday, but its only Wednesday. I think medical school is just going to go by as one exhausting long blur of studying and activity. But I am learning so so much and getting great experiences already. Lets just hope the rest of the week is a little less painful and that at some point I actually catch up with my studying...

Working for the Weekend

As always, this post is super long. You can just assume they will always be fairly long, I guess I have a lot to say!

So the rest of the week was pretty much more class and more studying - and more changes to the study plan.

Taking notes in the syllabus handouts failed, so back to taking notes on the power points. I am only behind four classes right now (as in I need to outline them), and have all night tonight and all morning tomorrow (classes moved to the evening because of Irene) to get those done so I am ready for week two.

Thursday we had our first Interviewing class, where we travel to hospitals / homes for the elderly to work on medical interviewing and establishing a doctor-patient relationship. All of us dressed up for class, which was really cute, and then we headed off to our sites. I was at a home for the elderly (which sounds like a super happening place to live!!). I met with my interviewing group (me and three students) and my M12 (4th year) student-teacher and we decided I was going to take a crack at interviewing first. I was a bit nervous, but I generally like talking to people, and all we had to do was ask about their medical experiences and life story, so I figured it would be ok.

We walked into the room and met the tenant and after the first two questions I asked, I realized I would have to change my interview plan. Our tenant, an 80 year old Chinese woman, spoke very little English and had a very thick and difficult to understand accent. It was uncomfortable, challenging, and awkward to interview this woman, but I did get a good bit of relevant information out of her, and my M12 teacher said if I had her as a patient I would be given a translator, and that I did a good job considering. Another kid in our team, my neighbor Scott actually, interviewed an awesome Russian lady and did a great job. Both tenants were really interesting and had great stories to tell!

Thursday night everyone went out. We had about 5 birthdays this week between all of our classmates, so we met up at Biddy Early's, a small dive bar. I went home early to study with a friend, and a bunch of my classmates were hanging out with my roommate at our place. I hung out with them, studied, then went to bed.

Friday I had class, ate lunch at school with classmates, and then studied for HOURS. That night, two friends and I got dinner at Ayana Sushi in Chinatown (super de-lish, super cheap - definitely going back), then later went out to Goodlife near Faneuil Hall for some drinks and dancing. I love my classmates, because so many of us are willing to get out and dance even though we look silly.

Saturday morning Tim arrived from Maryland to visit me and see Boston for the first time. My friend Nami (who I had been studying with all week and I love!) was sleeping over because of the stormy weather, so we all cooked chocolate chip pancakes. Then I took Tim on a tour of Tufts and we ran into a classmate and spent an hour at his house talking and listening to music. Later, we went for a walk through the Boston Commons and the Public Garden, then got roped into a 90 minute walking tour of the Freedom Trail with a large man in colonial dress. It rained the entire tour, but we had fun and learned a lot about Boston and I got some tips on things I need to do while I'm here! The tour ended at Faneuil Hall and Quincy Market, so we checked those out and then headed home to dry off.

For dinner we went with Nami to Bella Vista, a cute Italian restaurant on Hanover street (AKA Little Italy) and then got an Oreo canolli at Mike's Pastries. That night we went to my neighbors house for a party, but since our apartments dont have AC, it got sooo hot in there, so half of the party came to my house to distribute the warm bodies. We all met up later at Side Bar near Downtown Crossing for KARAOKE!!! I sang "I will survive" with a big group of classmates and we had an amazing time!

Today we (roommate, Nami, Tim, and I) bummed around a lot because Hurricane Irene was here, but decided to brave the storm for some Dim Sum. Tim had never been and doesn't like Chinese so much, so the girls ate like pigs and he tried a few things. We finished off the meal with red bean paste buns - YUM! We are heading out tonight to meet up with Tim's friend who also lives in Boston.

Irene has been pretty annoying (the T is closed, its gross out), but luckily we still have power and didn't have to resort to the gallons of water I bought...So no harm done!

All of the studying I did last week was totally worth it because I've gotten to actually enjoy the weekend! So it was all worth it after all!

What a Week - Oh Wait its Wednesday

Blogging is GREAT for procrastination!

Tuesday I had 4 hours of Physical Diagnosis, Genetics, Biochem, and Cell Bio in the morning, then had a lunch break for an hour and half - made a card for a classmate's birthday and ate some soup - then headed to the M&V building for 4 hours of MPH class. After a year off from school, 8 hours of class was awful. I almost fell asleep twice and was super restless and fidgety. Immediately after class, I ran to catch the T to Malden for Sharewood, Tufts' student-run free health clinic. Stayed there for 5 hours. My day ended up starting at 8:15 and ending at 11:45, with only a 1 1/2 hour break. Pretty tiring. Then I decided to study and skype, and went to bed at 1am.

Lets backtrack for a second, because I am being too negative. Sharewood was AWESOME!!! Because of patient privacy, I can't say too much, but I got to speak with, interview, educate, support, and help diagnose patients with second years, other types of students, residents, and physicians. I worked  with (more like shadowed) the Sexual Health Team (super amazing group of people - and mostly MD/MPH students!) which just added a woman's health room for pelvic and anal exams.

At Sharewood, medical students and other Tufts volunteers basically do all of the administration, check-in, interviews, blood tests, injections, and educational aspects of the clinic, and the residents / physicians write scripts, do more personal exams, and make sure we don't mess up. Everyone was really nice and worked together as a team. The doctors taught the residents who taught the second years who taught the new people (like clueless me), and everyone was willing to own up to mistakes and explain what they would do differently next time. Mistakes happened and were fixed, and the patients seemed to be happy to get free health care and contribute to our learning.

I loved it. But I may not go back for a few weeks because everyone in my class wants to try it out, and there were way too many people and we got in the way. Also, MPH classes are EVERY Tuesday, so if I want to do Sharewood, my Tuesdays are always going to be 8am to 11pm with little to no studying. Not good... But I loved the clinic, loved the patients, love the idea, and don't get to shadow doctors this year because of the MPH program, so would like to have some patient interaction, and this seems to be the right place to find that!

Today was okay. I was super tired from the long day yesterday so I slept through my second two classes. My friend who always comes over to study and eats my food cooked me lunch, so that was awesome. Also, my classmates gave me their notes for the classes I missed (yay teamwork!) and helped me figure out what I need to know, and I spent the rest of the day studying in the library with friends / at my house. I also cooked and cleaned a bit.

Its funny because its day 3 and I am so behind. I have 5 more classes to go through and outline, and each takes 1-2 hours. And if I don't do it today, then I will have 3 more classes to add to the list tomorrow... I feel so behind, but thats normal according to one of the second years I shadowed at Sharewood who is super super sweet and helpful. I just need to do my best. I will probably do two more classes worth of work, then go to bed by 1030.

So, I am changing the study plan. Already. No more reading / highlighting before class (pointless and time consuming). Take notes in the handouts during class then make outlines after class. That will cut out about half of the work I am doing. I am concerned that taking notes in the handouts won't work as well, but this week is a good week to try out different strategies, so here goes.

The Really Real Actual First Day of Class

Today was the real first day. I know I keep saying that its the first day, but this time I mean it. We actually had class, so this is the first really real day. Really!

This weekend was a little fun and a lot of work. More festivities and a lot of time spent on an essay I had to write for my MPH class. The essay was on the socio-ecological model for solving public health issues, and my focus issue was adolescent obesity. So I learned a lot and wrote a four page paper. I also had a LOT of reading for my MPH class, like 200 pages or more. I spent all day Sunday in the library with my MPH classmates and some over-achieving MD students (studying IN ADVANCE!) and we had fun goofing off and joking around with eachother. I didn't accomplish much during the group study, but I finished the paper and the readings and had a really good time and got to know my MD/MPH crew better. I really do love them, and am so happy that I get to spend extra time with them this year!

Sunday night a bunch of us also ordered Chinese from our favorite Chinatown place (Great Dumpling House - its soooo good!) and hung out at a friend's house. These three girls have two kittens, and we had fun eating, feeding the cats, and playing BOGGLE!! I suck at Boggle by the way, but it is a really fun game!

Monday came and we had Biochem, then Patient Presentations on Cystic Fibrosis, then Cell Biology, then a lunch break, then a student organizations fair, then an MPH presentation on summer opportunities by the MD/MPH class above ours. Looong day! The good news is my professors are all really nice and funny and legitimately good teachers, so the lectures weren't too bad. Plus I have already learned a lot of the material we are doing from undergrad (not that I actually remember much, but everything is familiar). The issue is what I've heard it was going to be - there is waayyyyy too much material. The analogy I have heard from second years is that med school is like drinking water from a firehose... I looked over the material for tomorrow and its almost everything I learned in a month at UCF - as in a month's worth in all 15 credits - in two days of med school. Its quite a lot. But I am VERY on top of the studying (its only day one, I know, but let me be positive here!)

The study plan: read and highlight handout material before class, take notes in class, transcribe notes into handouts after class, go to the gym, write outlines using the handouts with the notes. Good plan, but it involves about 3-5 hours of studying a night. And the gym. Probably not a sustainable plan. But a friend from Maryland is visiting this weekend (yay!) so at least for this week I need to stay on top of things. And I have succeeded for day one, even with the extra MPH coursework! So there, med school!!

My dad broke down my med school costs and told me that each day of school I am basically spending $220 to be there. Today, I got at least $220 worth. I heard from a doctor and her patient about the complications of cystic fibrosis, had two amazing lectures from really cool professors (one who lives on a boat in the Boston harbor while he's here!), got involved in a bunch of clubs, learned about summer abroad opportunities and grants, and even went to the gym (well kind of, it was closed so the roommate and I went up and down the 9 stories of stairs twice...). So Dad, today was a success!

I also hung out with a non med school friend from Gainesville, the roommate and I made dinner, and I studied with three classmates throughout the day. Because my apartment is so close to school, it seems that people will be coming over a lot to study or chill. We have had at least 6 house guests so far! It is fun to have people over, and good to spend time in smaller groups rather than the overwhelming mess of orientation last week.

Overall, today was crazy. Tomorrow is looking equally hectic (MD class 8:15 - 12, MPH class from 1:30 - 5:30, and then I am going to volunteer at Sharewood, the free clinic!!!) I am so excited to volunteer at Sharewood and really hope I like it (these days the plan is to work with under-served populations, and if I don't like the free clinic I am going to need to change the plan...). I also am now a member of almost all the student orgs offered here at TUSM (including Hillel!), and will see where that takes me.

Goodnight friends! If you want a more personalized update, feel free to email / facebook / call me and eventually I will get back to you!

More Oriented

Day 2 - Stayin' Alive!

Day 2 consisted of a lot more mingling, a bunch of lectures that I already don't remember, and our Basic Life Skills course. We learned about our curriculum, which seems really well thought out, and again everyone who spoke to us told us that their doors were always open. That has been a theme of the week and it is nice to know that the dozens of faculty members we have heard from are all really nice and actually care about us and how we feel.

After a long survey for some kind of study someone is doing (about how we felt about becoming doctors and our perspective on the doctor-patient relationship) we had a refresher course on Basic Life Support and learned why CPR has changed and what is most effective. We also learned that you are supposed to compress the chest at a rate of 100 compressions / minute, which corresponds to the beat of the songs "Stayin' Alive" and "Another One Bites the Dust."

After lunch we had the Basic Life Support test. We walked into the simulation center, where they have different fake humans that we could practice CPR on. These mannequins had little green lights that would turn on if you were doing CPR correctly. Basically, this test, which was my first test in medical school, was really easy. Overall, I just really hope I never have to do CPR because it is scary and actually really difficult to do correctly over a sustained period of time. And real people don't have little green lights that turn on if you are doing it right....

After that was a break! A friend ended up coming over to hang out and we had fun chatting. That night, I wanted to go to a Tchaikovsky concert but had to wait for a plumber to fix my shower. I ended up going to a party at a friend's house and then to a bar called the Hong Kong which is in Cambridge. The bar is famous for its Scorpion Bowls, which are large bowls full of different juices and alcohols. I tasted one, and they are really sweet and not my favorite drink I've ever had... It was a really fun night, though, and my classmates sure seem to know how to have a good time! I made a lot more friends which is exciting, and Cambridge is a cool place to hang out!

Day 3 - Field Day!

Again, lots of lectures in the morning. We heard from a student panel about diversity which was really interesting and had a lab safety speaker and a professionalism speaker. We also heard from the student council and the alumni president. A lot of jokes about meeting our husbands and wives, a lot of jokes about how nervous we all probably felt. Pretty much every speaker sounded the same...

But then, we got on buses and were shipped to the main Tufts campus in Medford for FIELD DAY!!! We were emailed by our group leaders and told what colors to wear and what country we were in. I was in USA and so I showed up for the day in a red and white striped pirate shirt and an American flag bandana. My classmates were in normal gym clothes, so I got a lot of compliments for being spirited. It was kind of embarrassing, but I survived, and now my classmates think I am fun, so I'm not too mad about it!

Field day was super fun, each team had two Learning Communities in it, so for each task we competed against each other within our group, and then we all competed as a country. They had us play silly games like charades and amoeba where we had to join hands in a specific way and run as fast as we could through an obstacle course without touching cones. We also had a few relay races (changing in and out of scrubs as fast as possible) and other goofy games. Our team got really into it and it was so fun to be outside running around rather than sitting inside! The class above ours planned the whole event and really worked hard to make it fun for us!

USA ended up in a three way tie for last place, and my Learning Community, Maimonedes, came in third out of fourth. Harvey won it for the Communities, and Norway (dressed in Viking hats and aluminum foil sheilds and swords) won the gold medal. They even played the Norway National Anthem when they presented them with their medal (AKA the lid of a bucket spray-painted gold).

That night we had potlucks in our different neighborhoods. I live in Chinatown and my potluck was awesome! I copped out and made brownies, but Olivia made this amazing curry dish. I am excited / super jealous that she is such a good cook, and I hope to learn some kitchen skills from her!! A lot of classmates and upperclassmen live in my building, and we have been sharing cabs and walking home from events together. I love my neighbors. After the potluck, Olivia and I walked to a friend's house and played with their kittens!

Day 4 -Finale

The last day of Orientation was pretty calm. My favorite was the lecture and panel on community service-learning. There are so many opportunities to serve as a medical student, and I really want to get involved in ALL of them! One of the opportunities discussed was Sharewood, the free health education organization run entirely by Tufts students. The clinic offers a lot of services, but the main point is to encourage people to get health insurance and find a PCP (primary care physician). Apparently everyone in my class is going to sign up for Sharewood, but most people stop going as the year goes on. I want to go, so we will see if I can get a spot eventually. Another option matches medical students with pregnant teens. And they also touched on international aide programs. I want to do it all, but hopefully I will restrict myself to a reasonable amount of extra-curriculars.

After the presentations we had a library tour and lunch with our Peer Advisers. My adviser is cool, but he isn't really involved in anything and is super into the gym. Not bad things, but he is very different from me. He was really nice though and willing to answer any and all of my questions.

Then I went to the Grafton Veterinary campus with the MD/MPH class to say hey to the DVM/MPH students. We got to tour the wildlife hospital, small animals hospital, and large animals hospital, which was so fun. We saw a tube feeding of a bird and a bunch of sick dogs which made me pretty sad. We also saw one week old kittens!!! It was a gorgeous campus with lots of green space and it was fun to see what the vet students are up to! I also love my MD/MPH classmates and our teacher, Tony, so the bus ride was a blast and we all got to bond some more.

When we got back, I made dinner with a friend and we headed out to a fundraising party at Jose McIntyre's. Everyone in our class and the class above ours seemed to be there, so it was packed. We all danced and I had an amazing time!

Reflections

So over all, the week was a huge blur of lectures and social activities. No medical school classes just yet, but I do have a paper due Tuesday for my MPH class that I have been working on all day (yuck!!). We got our packets for the first block of classes and it looks pretty intense. Monday we start Biochem, Genetics, and Cell Biology as well as Interviewing, my MPH classes, and small group Problem Based Learning Sessions. And Monday is the Student Activities Fair so I will get to learn about clubs! 

Update again on Monday after class!