Stem Cells and Starry Skies

So in Cardio, whenever I would inevitably freak out about information overload and my impending failure (which never happens thankfully), my friend Wendy would remind me that "It's just a pump." , So if I had to sum up the other blocks, Pulm was "just breathing," and Renal was "just filtering." I guess I could say Heme/Onc is "just a stem cell," but man do stem cells do a lot of different things. Like become cancer, or all of your blood cells.

I like art. And I like pathology (which most of my classmates would probably judge me for). They both involve looking at images and appreciating the thing that makes the image special. Pathologists like to compare most things to food. Worst example: gross (as in visable with the naked eye, but also nasty) pericarditis looks like "bread on butter." Only a pathologist would make me cringe at the thought of buttered toast. But in Burkitt's Lymphoma, the pathologists decided to compare the lymph node biopsy to a "Starry Sky." I like this comparison, and I love Van Gogh (I know, Starry NIGHT, but similar!), so I decided to share this random bit of pathology with my few blog readers. So you can see the "Starry Sky" - the white spaces, or "stars" are the tingible-body macrophages which have more cytoplasm than the numerous cancerous cells that have round, dark nuclei, creating the purple-y "sky."

Real Starry Sky!

So what is Burkitt's Lymphma? It is an aggressive cancer (Non Hodgkin Lymphoma) of the lymph system that can be caused by Epstein Barr Virus (AKA mono). It is common in equatorial Africa. Sad stuff, but cool pathology.

Back to Heme/Onc study! Happy post-Election day - I hope you are all as happy as I am with a majority of the outcomes (yay human rights and Obama!).

From a classmate: SECOND YEAR IN FLASHCARDS

Health Law and RU-486

Despite the fact that I roll my eyes any time I hear anyone discuss law, I am going to attempt to blog about law.

This semester, my MPH cohort and I have been arguing every Tuesday in an amazing Health Law course. Our professor literally wrote the book on Health Law, and we have learned a lot of terrifying things about what we should and shouldn't do as doctors. Like give out free health advice. So, present friends - all of my present and future advice means NOTHING. I am NOT your doctor, and you should go see your real doctor if you are less than perfectly healthy. So throughout the course, all that my class of future doctors can do is groan in anguish that yet another case seems to say that even when the doctor tries to do the right thing, they are liable for their human mistakes and tough cookies, but they are going to pay the price.

Enough on law class. Now, a case. I recently researched this case for a meeting I helped host for pro-choice grad students in Boston (if you want to come to these meetings, let me know!!). The following is what I was able to decipher from the legal jargon, along with a heaping dose of my opinion, and a pinch of medical fact.

A woman from Idaho found an online physician to prescribe and send her an FDA approved pharmaceutical called RU-486, which she used to end her pregnancy (medical abortion). In the case (McCormick v. Heidman), the 9th circuit court decided that she could not be prosecuted because of limited access to abortion and her right to life and liberty (14th ammendment) up until fetal viability (24 weeks).

When patients are counseled and followed by health professionals, medical abortions are very safe. Women take mifepristone (RU-486) which blocks progesterone, causing the lining of the uterus to break down and the cervix to soften. Misoprostol completes the procedure, by causing the uterus to contract and empty. Women undergoing medical abortions experience some pain, cramping, and heavy bleeding. About 98% of the time, medical abortions successfully end the pregnancy with no complications. Few women may need a procedure to empty their uterus, very few women may need a blood transfusion, and of a whopping 1.1 million cases, only 7 have been fatal. Biggests risks: blood loss and infection.

If you know me at all, you know that I am pro-choice (and pro-life according to this great article). My issue is - if this woman got RU-486 online, how did the doctor know how far along she was, or if she was eligible for this type of abortion. This doctor is not available to help in the rare case of complication. The patient can't follow up to make sure the medication worked. There are definite ethical implications of this court decision. I am not sure if proper care can be given over the internet. Then again, if the government didn't limit women's reproductive choices and more physicians became abortion providers, these types of problems wouldn't be encountered. I am glad that the 9th circuit decided that McCormick could not be penalized for making a decision about what was best for herself and her family. I just wish that McCormick had more options.

On that note, you can find a pro-choice voter guide here --> CLICK ME!
(And Floridians - vote no on amendment 6!)

Broken Heart Syndrome

Today marks the halfway point in the cardiovascular block of second year.

I spent a lot of time figuring out how to read EKGs for different heart problems, and then got to diagnose someone in clinic the next day! My clinic partner and I correctly identified ST elevation, T wave inversion, and Q waves that suggest recent myocardial infarction (heart attack!). Not good news for my patient, but glad we caught it so that he could get a complete heart check-up to make sure he is okay. This is the progression of EKG changes in ST-Elevation Myocardial Infarction (STEMI):

Learning about heart disease is scary because it is soooo common and soooo serious. Not to mention that almost every risk factor for heart disease runs in my family. I better stay on my workout schedule!

Broken Heart Syndrome

Yesterday, appropriately enough, I saw a heart disease on twitter that we didn't learn about in class: Takotsubo cardiomyopathy. Because this heart disease is most commonly caused by emotional stress, such as the death of a loved one or a break-up, the condition is also known as broken heart syndrome. It is most common in post-menopausal women, and can also be caused by a physical stress to the body.

A = left ventrical apex weakening, B = octopus catching pot

The stress of heart break increases levels of catecholamines, which can cause sudden temporary weakening of the myocardium (heart muscle) at the apex of the left ventricle. The base of the left ventricle works fine, but the apex balloons out and is unable to pump well (akinetic), causing symptoms that mimic a heart attack (including chest pain and EKG changes shown above). The heart ends up looking like a Japanese octopus trap, a tako tsubo, hence the name of the disease. Luckily, these patients are unlikely to die of this disease if it is treated acutely, and the broken hearts heal in a few months.
The main difference between a broken heart and a heart attack is that these broken-hearted patients have little or no coronary artery disease. The stress causes their heart to dysfunction.

I'd say that broken heart syndrome calls for a prescription of ice cream, tissues, and support from friends, but these patients may also want some beta blockers and aspirin.

And for fun, a print of the heart that I made in an undergrad art class. Hearts are fascinating (and complicated) structures. My print may not be anatomically correct, but I dig it.

Second Year Analysis

Being a second year is pretty crazy. In the two first weeks, I went through 3 pens, an entire 70 page college rule notebook, and half a pack of loose leaf notebook paper. And I learned everything I need to know about lungs. Three weeks later, I had mastered the kidneys. A week after that and I am half way through the cardiovascular system.

I definitely liked Physiology in college. Learning how organs work. Pretty fascinating. But now, as a second year medical student, we don't just cover the basics. We really have to understand the who, where, what, when, how, how likely, in what order, what dose, what color, and any other question you could ask regarding physiology and pathology of the body systems. And we have to understand these concepts in 2-4 weeks per system. I have been getting pretty frustrated. I can't type fast enough, can't focus my attention long enough, can't learn as thoroughly as I would like. I keep thinking about my future in rotations, maybe in residency, maybe as a practicing who-knows-what-kind-of physician. I meet a patient with any one of the hundreds of pathologies we have learned, and I blank. Bad news for my patient, and I sure look like an idiot. All because I didn't learn it second year.

Except that's just my imagination getting the best of me. Medical school is alllll about repetition. We have already repeated certain important concepts dozens of times, and in rotations/residency I will see them again and again and again before I ever see patients on my own. With time, these abstract and ridiculous concepts will be drilled into my head and my future hypothetical patients won't end up with me looking back with a blank face. Also - doctors don't actually have to remember all of the lab values and formulas and concepts and medications. There are apps for that...

So really after thinking about it, second year is just the first run through for each system. Every out of breath patient, every patient on dialysis, every patient with heart disease will drill in the concepts that I obsessively pour over until my fingers are black from ink and numb from writing/typing. Maybe I just need to remind myself to take a chill pill and learn what I can when I can. Which means adios to my blog and back to learning about EKGs.

*Because of my lack of fun medical facts, here is a scary pic of what sudden cardiac death looks like on EKG (v-tac, v-tac, v-fib, a-systole). Let's hope I don't see this too often in my patients.

Kidney Facts and Doodles

I have been bad and haven't posted yet during our renal (kidney) block. The test is tomorrow, so I guess I have to post today!

The past three weeks have been kidneylicious. Normal kidneys look like, well, kidney beans. But pathologic kidneys can be pretty funky. Autosomal dominant polycystic kidney disease (ADPKD) is especially horrific. The kidneys can get bigger than your head, and they have gross balls of fluid in them that the pathologist decided to pull out and display on the table and squish around for emphasis. Gross. See the ADPKD pictures below....YUCK!

My favorite thing about kidneys is that they seem to make no sense until you really really understand everything. For example, the volume of water in your body depends on salt intake / output, not how much water you're drinking. And the amount of salt you have depends on how much water you drink. So to the kidneys, water = salt and salt = water. I promise it makes sense once you understand all of the hormones and transporters (a nice and simplified diagram of the transporters can be seen below, along with kidney doodles).

Fun fact - although Weight Watchers and famous TV hosts say that we should drink eight glasses of water a day - it IS NOT TRUE. At least according to the nephrologists (Kidney Doctors). They say you know when you need water because your brain (anterior hypothalamus) senses that you are water low (hypernatremic), causing your brain to make you thirsty / retain water (side note: the hormone that does this comes from the same place as OXYTOCIN!). So drink when you are thirsty and you should be fine. I asked if drinking water helps with weight loss. The nephrologist didn't really know (or seem to care). Too busy to research that, but your kidneys do not need eight glasses of water a day! I always hated having to pee all the time from all that healthy water. Turns out, I was wasting my time peeing. 

For my excersizers out there - DON'T TAKE NSAIDS (anti-inflammatories - like aspirin/ ibuprofen / naproxen) before strenuous exercise (like a marathon). NSAIDS inhibit prostaglandins which help keep your kidneys moving during low volumes (AKA when you are dehydrated from your exercise). Also, drinking too much water during a marathon can also cause you trouble. Basically marathons are dangerous.

Kidney Doodlings

Yes, this is simplified...

Hypertension (high blood pressure) depends a heck of a lot on the kidneys. And I finally understand how to treat it thanks to an AMAZING lecture by our course director. There are tons of meds for hypertension, but it really doesn't matter what you take (unless you have other diseases or specific side effects), and apparently thiazide diuretics are a good choic first anti-hypertensives. Also, if you are hypertensive, just keep your blood pressure as near to 140/90 as you can (again, unless you have other diseases - like diabetes - then keep it close to 130/80) because below that you don't have much lower mortality. Also, your meds won't help you unless you actually stop eating so much dang salt.

So tomorrow I can say Goodbye Kidney (no cute graphic for that one)... or at least until I encounter my next hypertensive patient.

Don't Fall Asleep - Pulm Block and Ondine's Curse

Summer is over, and I am back in Boston for Year 2 of medical school. ACK! Things aren't really all that different, but at the same time everything has changed. This week was orientation for the new (and adorable) first year students, and a big reality check for me - medical school is back and it is no joke.

Second year is about systems - we learn function and dysfunction in each system of the body. They started us off with pulmonary! We had 18 lectures this week, which I may have thought was nothing last year, but now seems impossible to keep up with. On top of lectures, I learned how to draw blood on a boy in our class with veins the size of my pinky finger, reunited with my classmates, and also tried to help with first year orientation. I attended numerous social events, forgot a lot of names, answered a lot of questions, acquired a first year mentee (and many unofficial mentees), co-hosted a potluck, and was captain of Team China for the First Year Tufts Med Orientation Olympics (see photo - I face painted my co-captain into a Panda).  Upside to all of these activities: lots of free food. Downside: I am sooooo tired!

Speaking of sleepiness, we learned about a crazy sleep related pulmonary disease that I think is share worthy. It's called Congenital Central Sleep Apnea, but is also known as:

 ONDINE'S CURSE.... dun dun dunnnnnnnn

The disease nickname comes from a German folk tale that goes like this:

Ondine was a water nymph that fell in love with a mortal human named Palemon. Knowing that falling in love with and bearing the child of a human would cause her to lose her eternal youthfulness, she weaseled Palemon away from his current fiance and married him. When they exchanged their wedding oaths, Palemon promised that every waking breath he takes would be a testament of his love for her. After having their son and losing her eternal youth, she caught Palemon naked and asleep next to his former fiance (once a cheater always a cheater...). To force him to keep his vow, she cursed him so that he would only be able to breathe while awake and able to remember to take each breath. Eventually, he fell asleep, stopped breathing, and died.

Patients with Congenital Central Sleep Apnea have abnormal autonomic control of breathing (abnormal breathing without thinking). During the day, they can consciously control their breathing, but at night when they depend on autonomic control, they experience periods of apnea (AKA they stop breathing altogether). Just like Palemon... but I don't think these patients ever cheated on water nymphs. Luckily, this is a rare genetic defect and there are only about 300 known cases of the disease, and severity varies. CCSA patients can live normal lives if they use a ventilator when they sleep.

There are lots of mechanisms that make your body breathe when you aren't thinking about it, or even when you try to hold your breath. Most importantly, chemical receptors check your blood for oxygen and carbon dioxide. When oxygen gets low (hypoxemia) or carbon dioxide gets high (hypercarbia), these receptors send messages to your brainstem to speed up and deepen your breathing. This system fails in CCSA patients.

So I may be sleepy from my first week back, but at least I won't stop breathing when I finally get to hit the hay!

The Nicadventures of Lisa Kip

I know I've been silent for a while, but I have a pretty decent excuse. Nicadventures. All types of wonderful and interesting Nicadventures that I have been saving up for my blog!

Chapter One, My Nica Family

I arrived in Nicaragua full of questions. As a Type A individual, I wanted to know the whos, whats, whens, wheres and whys. Well The Whos are my wonderful Nica family!

• Of course Audra, Nate, and I are the terrible triplets - always bickering and getting into trouble.
• Jean-Pierre, our older (host) brother,  is fun and exciting and always doing something way cooler than us (IE teaching pilates at our favorite gym or being a bacanalero at the local club).
• Our little (host) sister, Ma-Fer, likes to laugh at our (Spanish speaking) mistakes, show us her new shade of nail polish or scream about the latest sexy futbol player (PIQUE!). 
• My host mom, Doña Rosario, makes sure we drink our suero (lemonade) when we have a tummy ache, and tells us fascinating stories about her own adventures as Minister of Health under former Presidents
• Aunt Mariana takes us out to dance and invites us over for pitahaya juice on her porch, where we help cousin Luz with homework or watch her play on facebook. 
• The volunteers come and go, but each one becomes part of our Nica family for a short time.

I love my Nica family, it has been so much fun to get to know everyone here, even though they are almost as crazy as my family back in the US. Well, almost...

Chapter Two, The Job

My bosses, Corey, Lara, and Brady, check in from time to time, but mostly leave us to our work.

Monday and Wednesday we teach Health to 5th grade, and Sex Ed to 6th grade. In Spanish. I have learned that I hate lesson planning, and that teaching in a language you don't really speak is a challenge. The kids are great, and the 6th graders have NO sex ed knowledge so that class is super awesome and exciting (which translates to emocionante, not exitante - which means arousing).

Monday afternoon we have Nutrition class with Public Health Hero #1 - Eugenio, or as we refer to him - The Genius (El Genio...Eugenio...get it?). Eugenio cooks us lunch every day, and never fails to impress us with amazing and unique healthy meals made with the 10 cardinal ingredients used across this country. He also knows tons about health, nutrition, and the art of cooking. We are in charge of a Weight Watchers style discussion during the class - this week we talked about portions control for example.

Tuesdays we give trainings to the promotoras, or community health workers of our community. We have given presentations on mental health, nutrition, stress, meditation, and BMI. Also, we have helped train the promotoras on taking blood sugar, blood pressure, pulse, respiratory rate, and giving subcutaneous insulin shots.

Tuesday and Thursday afternoons we have dance class with Cyndi. We shake our booties and sweat a TON in the non air conditioned school, and always make sure to laugh a lot. We also weigh the attendees in and give them their weight losses for the week along with information about a healthy goal weight based on their height.

Lately, we have been working a lot with data - information from school physicals that were done in May, and information on the promotoras. We are collecting the data to help with grant writing, but have also learned a lot of interesting things about the community we work with in Camilo Ortega / William Galeano along the way.

Thursday morning we have clinic - where we help in the pharmacy, take blood pressures, or shadow the main clinic doctor, Dr. Romero. Last week we had gynecology consults with a different doctor and got to see lots of cervixes and learn about the differences between Nica and US gynecology.

Basically, we stay busy. Many nights we work late or have to scramble in the morning to make things work. However, I wouldn't want to leave anything out, because it is all amazing and fun and interesting and different...

Chapter Three, Free Time

On weekdays, we mostly Skype with friends and family and then run to Master Gym for Aerobicos at 7pm. We try to keep up with Geovany's Latin rhythm while the entire gym watches in amusement. We get home soaked in sweat and starving for home cooked Nica meals. Good times. We also sometimes hit the town in Managua with friends or other volunteers, head to the mall, or watch movies with our host family.

Weekends have been incredible. I have gone to San Juan del Sur (x3), San Juan de Oriente (x3), Masaya (x2), our host family's finca (farm), Volcan Masaya, Omotepe, Granada (x2), Las Isletas, and Laguna de Apoyo. My family came to Nicaragua for a weekend. I climbed a Volcano over the course of 11 hours. I attempted to surf (fail). I caught a fish and ate it that night. I spent the day on an isolated beach. Weekends have been amazing.

The funny thing is, after 6 weekends here, I have still only visited maybe 1/3 of the places I want to see in Nicaragua. I would love to see the Corn Islands on the Atlantic Coast, the jungles of Rio San Juan, the jungles and mountains in Northern Nicaragua, the intellectual town of Leon, etc. etc. etc. I have a few more weeks. I'll see what I can accomplish.

Chapter Four, La Enferma

I have gotten sick a fair number of times - my host mom likes to call me "La Enferma". Of course, the obligatory intestinal tract infections. I have had two. I'll spare you the details. Luckily, my host mom, Loperamide, and Cipro nursed me back to health. Also, after climbing Volcan Maderas, I found a pretty weird rash on my right thigh. I will hopefully blog about that next, so stay tuned.

Sometimes I feel like I am ready to go home, but most of the time I just wish I had more time here. More time to relax. More time to explore. More time to make more change with more Spanish and more knowledge. But looking back on the chapters I have filled so far, I am more than satisfied with my experience. And it's not over yet!


Other things I failed to mention: Olympics with 5th and 6th graders, what I've learned about politics in Nicaragua / US involvement in Nica history, my two other public health heroes, the foods I have eaten, slang, etc.

Como ATRAVESistes?

My first day in Nicaragua, Audra told me that here in Nicaragua, instead of "good morning," you say ¿Como amanesistes? I forgot the next morning, and instead said ¿Como ATRAVESistes? ATRAVES is the organization I am volunteering with this summer. Audra, Nathan, and I are doing public health initiatives in Camilo Ortega, a bario or neighborhood on the outskirts of Nicaragua. So now after work, we ask eachother, ¿Como ATRAVESistes?

Nicaragua is an amazing country. I am learning so much every day - about the language, culture, traditions, history, oh, and of course FOOD!

This past week played out somewhat like an orientation to my life for the next nine weeks. I met my amazing host family, got to train and do home visits with a community health worker (every global / public health workers' dream - see photo below!), and  spent a lot of time trying to understand what people are telling me in Spanish...

Volunteers teaching the promotoras how to use a glucometer

During our time here in Nicaragua, we will be doing a lot of projects, but most focus on health education. General health for fifth graders, sex ed for sixth graders (oy veigh!), and nutrition and exercise for the general community. We will also be working with the community health workers (here, we call them "promotoras") and will be volunteering in the open clinic once a week. We have a lot to do, and are so happy to be able to use the skills we learned in our public health courses to make some positive behavior changes!

So back to the food. Sadly, there is little interest in spicy food here. However, the gallos pintos (rice & beans) are to die for, and everything else is fried in tons of oil. So to combat the new diet, I found a gym! My host brother Jean Pierre is a pilates instructor, so we go with him to Aerobicos a few times a week. Also, sweating all day in the heat of Camilo Ortega is a workout in itself - we get so little work done compared to in the States just because we are so hot and tired all the time!

My host sister, Maria Fernanda del Rosario, or "Ma-Fer," is an amazing and spunky 16 year old with a heart of gold. She and Jean Pierre speak English, but their mom, Doña Rosario, banned English because I told her I was trying to learn Spanish... Oops. In the mornings they start chatting to me and it takes me about a half an hour to understand anything. Trying to learn Spanish is a challenge - I literally feel like I am thinking and focusing so hard all day. I can understand most conversations but miss out on things like tenses. So I will know that at any point in time, someone was, will be, has, may, or kind of did an activity. I understand a lot, but I need to learn more, and need to be able to conjugate verbs when I speak... Also, I sound like "I NEED GO KITCHEN NOW" when I speak - we like to translate what I said in hindsight. Also, a few embarrassing speaking errors: sopa means soup, not soap (jamon), and boda means wedding, not body (cuerpo). Awkward...

This post is getting rambly, I think I'll blame the heat for that. But to wrap up, here are some highlights:

Noni fruit

-went dancing with Audra's host mom at Chaman a club shaped like a pyramid that looks like it came out of Las Vegas
-saw (and smelled) a noni fruit - it supposedly can cure cancer and diabetes, but it smells and apparently tastes like barf...
-tried making a clay pot on a wheel spun by foot in San Juan de Oriente, an artisan town
-a visit to San Juan del Sur, a touristy surfing town where my MD/MPH buddies are staying for the summer, where they have iced home roasted coffee and beautiful private beaches.
-tried surfing in San Juan thanks to some super nice tourists who lent us their boards and gave us some quick lessons. I didn't stand, but I was knee surfing!
-took the chicken bus - a jam packed school bus that travels between different towns in Nicaragua. If you get on too late, you have to stand packed between vendors who hop on and off and different people and their belongings

My Donor

I started this post a month ago, but was too afraid to post it and got lost in the throws of finishing first year. However, before I discuss anything else, I wanted to be sure to discuss the most meaningful experience I have had in medical school so far. 

Throughout my Anatomy course, my donor, James would suddenly seem alive to me. A scar, the stubble on his chin, his thick head of hair - I would see something and it would snap me out of the current dissection and spin me into thoughts about what his life was like.  The first week that I met James, one of my lab partners pointed out a ghost-like divet of a wedding ring around his ring finger, and we all stood in silence reflecting on what that meant. James had a family. People were missing him as we spent hours getting to know him in such an intimate way. As the course went on, I learned everything there was to know about James's body - the curves of his brain, the tiny bones that allowed him to hear, the arteries of his heart, and even the pancreatic cancer that ultimately took his life. However, I was unable to discover how he lived, who he was, what he meant to the family he left behind.

At the end of our gross anatomy course, Tufts held a memorial service for the students and family of the donors to meet and reflect on the people that started us off towards our careers. On the day of the memorial I was extremely nervous. I mean, what do you say to the family? How can you truly explain how much the experience meant to you? I tried to come up with what to say before the memorial, but nothing felt right and I just hoped that if James's family showed up, I would be able to understand more about James's life and maybe bring his family some form of comfort in return.

The memorial was beautiful, thanks to the many talented students at Tufts. They wrote poems and reflections, sang songs, played instruments, and I felt that everyone in the audience was able to understand the gift that the donors gave us. At the end of the service, our professor asked if any family members would like to speak. One lone hand shot up, and a young woman was directed to the stage. She mentioned her husband James, or Jim, and pancreatic cancer and I knew she was talking about my donor. My stomach heaved and my eyes filled with tears. I was amazed at her bravery as she told us about Jim's decision to become a donor, his experiences as a medical student in gross anatomy, and how much it meant to her to meet us. As soon as the ceremony ended I sprinted down to meet her. And the first thing I saw was the ring on a necklace around her neck. The ring that left the divet.

James gave us many gifts as our donor -  knowledge, appreciation for the human body, an ability to understand the many terms we hear in our courses. However, Jim's wife filled in the empty spaces that the gross anatomy course left behind. I was able to comprehend the importance of compassion, empathy, and human experience. I was able to understand concepts that you can't find in Netters Atlas of Anatomy. His wife gave us a copy of the pamphlet from his memorial. We saw pictures of Jim and learned about what he was like in life. We learned about his family, his children, his passions, his interests. I will never forget the experience, and will never forget Jim or his family. I am so thankful for the experience that Jim and his wife gave me. As a team, they introduced me to the most important foundations of medicine. As I continue through my journey I can look back and remember the gifts that they gave me so that in return I can help my patients with both knowledge and compassion.

More Tricks of the Trade(s)

So by getting two degrees at once, I technically have two trades - medicine and public health. So here is a random trick from each:

MEDICINE TRICK
Do you take any medications? Think about it. What would you tell your doctor if he/she asked you? If you are a woman, you probably left something out. Birth control! Last week we had our first day of clinic, and had a few workshops to prepare. Here at Tufts we were taught to ask about "OCPs" or "oral contraceptive pills" in addition to asking if our patients take medications. More often than not, female patients won't remember to list their birth control under medication. It's silly, but it's common - so ladies, remember to tell your doctor that you are on BC if they ask you about meds!!

We were also taught to ask about herbs, over the counter medications, and complementary medicine. Patients don't necessarily lie (actually, they often do, not to quote House or anything...), but health care providers have to ask the right questions to get the right answers. Patients are tricky, so we have to be trickier.

Nope, not a real fly!

PUBLIC HEALTH TRICK

Last week we learned about Nudge Theory, which we can use to influence individuals to make healthier choices. Using Nudge Theory, we can discretely suggest that consumers do the right things without explicitly telling them what to do or taking away their options. 

The picture to the left is our example of a nudge theory. In Amsterdam, the janitors complained about the mess men left from splashing and or aim failure when using the urinals. To rectify this problem, rather then telling the men to aim better, they printed flies where they hoped men would aim. This small change reduced "collateral spray" by 80%. Without any actual demand or campaign, these urinals were able to nudge the urine streams in the right direction. Public health win!

Nudging happens all the time. Advertising campaigns try to nudge us to use their product with fancy boxes and fun designs. Another example in class was a group that turned stairs into piano keys - complete with sounds produced when you climb them. Tons more people chose to use the stairs over escalators because of this fun nudge. Here in Boston, Children's Hospital has piano stairs.

Another example is drawing footsteps on the ground towards the stairs rather than the elevator. People feel nudged to use the stairs in order to follow the footsteps. Nudge takes my new professor's favorite acronym into account. KADNAB - Knowledge Alone Does Not Alter Behavior! You have to inform people, but also nudge them in the right direction and teach them the skills they need to change their behavior.

More nudges here: http://www.inudgeyou.com/category/featured/

Eye Love Pirates (And My Class!)

Eyes. I hate them. We had a slide of an eyeball with a nail through it in the lecture titled "Head Trauma" and I almost barfed. 

But luckily, one of my classmates posted a little something on Facebook that made me like eyes today.

Courtesy of my classmate (we are supposed to call each other "colleagues" but I don't like it) Logan: "Fun fact: It can take the rods [cells that help you see in the dark] in your eyes almost 30 minutes to adjust to low light. This is why pirates wear eye patches. They are constantly moving from the deck of a ship (where the light reflecting off the water can be blinding) to below deck (often very dark). In order to save time waiting for their eyes to adjust, they just moved the eye patch over."

I almost fell over in my study chair that I've been sitting in since 10am (did you see how I inserted a complaint without complaining? It's a talent.) That is genius. Public health measure to stop the elderly from falling when they get up and go back to bed in the night? I think so! Eye-patches for the seniors!

On the subject of Facebook posts, our class is adorable on Facebook. Since we arrived in Boston in August, we have been posting things to do, Groupons, fun events, practice exams, study guides, tips from professors, and funny med school related websites or jokes. The posts don't ever stop. Double on holidays. I get five or more notifications a day. We love each other and it's so great. And so helpful to get advice from so many people. We actually have about eight ways to contact the whole class at once, and our class somehow uses all of them except the portal actually made for us to communicate by the university. I guess it's too "on-the-record" for us.

Here is another funny post. It's a website about what medical school is like based on another popular website., but I think anyone could enjoy some of the posts. CLICK HERE!!!!!

As always, I should be studying. Back to my chair. Oh wait...still sitting in it. 

And for fun, white board art (I prefer fun pictures to actual knowledge on white boards. Usually when you enter a study room there is an intimidating amount of info on the board. I erase the knowledge and add some fun to the study environment.)

Note the sheep, sheep-shaped cloud, school of fish, penguins, igloos, ice cubes, tsunami, raincloud, hurricane, tornado, surfer, my brain with a lot of oxytocin, and a whole lot of fabulous. These things get me through study weekends. 

Night!

It's a Marathon

Exciting news - Massachusetts has it's own holiday. It is technically Patriots Day, but around these parts, it's called the Boston Marathon!

So on Monday I walked over to the Prudential Center and watched people run. These people were amazing. Some were my age, but most runners were way older than me, and in waaaay better shape. Running mile after mile after mile in pretty ridiculous heat. I was impressed. Excitingly enough, 3 of my medical school classmates ran the marathon, so I got to cheer them on as they approached the finish line. Very fun, very exciting.

But of course, I didn't run the marathon, so to make myself feel better, I decided to relate my medical education to running a marathon (I can't physically run, but maybe my brain can!). I may only be on the first 5K of my med school marathon, but I am going at a pretty steady pace, maybe even picking up speed. The beginning of my dorky marathon metaphor was probably as terrifying as starting a real marathon. I didn't know what to expect and was pretty much terrified (I think I lost 5 lbs from being to nervous to eat back then). But I started and pretty much just kept going. I am assuming that during a marathon there are things like hills, cramps, exhaustion, anger, frustration, fear, excitement, feelings of imminent death, I could go on and on. And I am pretty sure I have experienced all of those already - or I could at least come up with metaphors for them. But here I am, sitting in a windowless study room on a beautiful day learning about the brain for my next exam (well, technically I am blogging, but when I am done, back to the books!).

I hope that I don't fatigue to badly over the course of my med school marathon, but right now I feel really far away from the finish line (which could arguably either be graduation or finishing residency). Thankfully I have a lot of people cheering me on at the sidelines, because without a whole lot of support and some serious brain stamina, I am never going to make it.

Med School Tricks and Tricky Topics

The Trick...
We learned a fun trick in med school! I taught it to some middle-schoolers recently and they loved it, so I decided to share it with my blog readers. Not saying that my readers have the same mentality as middle-schoolers, but it passed the likability test. Anyway here it is:

1. Locate a blank piece of paper.
2. Draw 2 dots about 5 inches apart.
3. Close your left eye.
4. Hold the left dot in front of your right eye and stare at it.
5. Slowly move the paper away from your right eye, constantly staring at the left dot.
6. Eventually, the right dot will disappear (but only if you don't look at it, you can only look at the left dot!).
7. You just found your blind spot!

Here is a picture of an eyeball (ew - tangent - I hate eyeballs, they creep me out. I will not be an opthamologist. Over the course of med school, I need to eventually decide what I want to do with my MD. Every once and a while I figure out I hate certain fields of medicine. Like Psychiatry and anything to do with teeth/eyes. I will keep you updated on my list of No-Way-In-Hell Specialties, as well as the Maybe Specialties - like Gynecology, Family Medicine, and Internal Medicine.)

See the thing called the optic nerve? It's actually an outgrowth of your brain that sends what you see back for processing. While it's awesome, it takes up space on the retina (where the images that you see are projected). So the spot where the nerves that do the seeing collect and project back, there is no vision. Luckily, you will never notice it unless you are looking for it with my fun trick - it is in your peripheral vision, and your brain fills in the spot for you.

The Tricky Topics
Last month, we started Neuroscience, Head and Neck Anatomy, and Psychology. Tomorrow, we start Addiction Medicine. These are tricky topics, not only because the brain is a pretty small structure with a lot going on inside, but also because scientists haven't really figured these topics out. They know where most nerves go and generally what they do, but there are a lot of complexities that are unexplained until further notice - making a lot of what we learn somewhat fuzzy around the edges.

Also, skulls are really complicated. See photo. We have to know what the skull parts are named, all of the holes, and what goes through them.

It's overwhelming but I do like Neuroscience, so I guess I'll leave Neurology as a Maybe Specialty...

Beware the Drape Monster

I always think I am finally all grown up and professional, and then I do something like this...

So at 5pm on Thursdays, I am usually pretty loopy. I have been on the go all week, and all of the relaxation I had stored up from the weekend is long gone. I am sick of sitting in the library and want to do something fun. Oh, except that I also have a two hour class called Physical Diagnosis (PD) on Thursday nights. In PD, I learn how to actually be a doctor by practicing physical exams that help us determine signs and symptoms of disease. 

By the way (I learned this last week) - a sign is something that we figure out based on our medical exam. A symptom is something the patient reports. They sometimes overlap, but  I didn't realize they meant different things until a professor decided to mention that. 

And while I'm on a tangent, I might as continue go to another one - professors often forget that we don't know the basics, so they will skip over/ use abbreviations / talk really fast about things they have heard tons of times, but we may have never learned them (#medschoolproblems).

Back to my story...in Physical Diagnosis last week, my partner and I practiced draping. My whole med school class seems to be afraid of draping. Draping is using the "johnny" (gown they give you at the doctor's office) and a big (napkin-like) cloth that they place on your lap to maintain the patient's decency during your exam. We weren't taught how to drape, and when doing some of the exams it is hard to keep the patient appropriately covered. For example, during the heart exam, you have to touch and listen to the heart at the "left 5th intercostal space at the midclavicular line." This spot of the body is pretty much right below the patient's nipple. So you have to practice covering a potentially female patients breasts while reaching up under their breast to listen to their heart. (The course directors told us to ask our patient to lift their breast out of the way - awkward!)

Think about the last time you went to the doctor. They probably draped you appropriately. It seemed so simple, right? As a physician in training, I can tell you that it's not as easy as it seems, and it takes a lot of practice to not be awkward and clumsy with the draping.

So my PD partner was practicing draping with me using the napkin-like drapes that they provided to us. By the end of the exam, my drape had ripped in 5 places. So rather than throwing it away, I decided to become the Drape Monster. Like I said before, by Thursday night, being cooped up in one building all week has taken it's toll. I had a case of what my friend Sara calls "Med School Fever."

Here is a picture of me, the Drape Monster:

But I feel that by mocking the drape, I reduced it to something that I no longer fear. Now, rather than the horrible awkward drape, it is just some silly piece of fabric that I need to use when I am (eventually) a doctor.

Obsessed With Oxytocin

My classmates know it. My friends know it. Almost everyone I meet knows it. It's pretty clear. I am obsessed with oxytocin.

What is oxytocin??

Oxytocin is a peptide hormone and neurotransmitter made in the hypothalamus. To the left is the molecular structure of oxytocin.

From the hypothalymus, oxytocin is either sent to different parts of the brain (acting as a neurotransmitter), or stored in the posterior pituitary for release into the bloodstream as a hormone. Below is a picture of oxytocin in the posterior pituitary waiting to be released (photo from my Tissue and Organ Biology course at Tufts).

But why am I so obsessed with oxytocin?!
In an endocrinology course in undergrad and again in a very recent physiology lecture here at Tufts Med, I learned that oxytocin is used to make the uterus contract during childbirth and to release or "let down" breast milk so mom can nurse baby. That was it. One slide, a few bullets, no big deal, not very exciting. But like most hormones, oxytocin is pleiotropic - it is made by one gene, but does a heck of a lot more than one thing. Oxytocin not only acts on the breast and uterus, it also can affect the brain, kidney, heart, etc. Oxytocin plays a huge part in biological and behavioral components of human life and is vital to successful development, successful relationships, and successful reproduction.


Oxytocin's involvement in human romantic relationships is really what drew me in. This one hormone seemed to explain why life and relationships are the way they are. 

Lucky for me, oxytocin has been gaining popularity recently. It has been dubbed the fantastic nicknames of the "Love Hormone" or "Cuddle Hormone." Scientists are currently studying tons of different ways oxytocin is involved in the function or dysfunction of our bodies, relationships, and minds, and they have started discovering potential ways oxytocin can help people suffering from a variety of problems.

So in this post, I am going to attempt to explain some of the wonderful things oxytocin does. I will try to keep it short, but I am obsessed, so bear with me or skip to a section that interests you!

1. Oxytocin and Bonding

When a baby breastfeeds, oxytocin is released to let down the milk in the mom's breasts. This oxytocin also warms the mother's body so the baby is comfortable. The baby is warm, has cozy cuddly feelings from oxytocin, is receiving some delicious nourishment from mom, and is able to build trust. Meanwhile, mom is being rewarded by oxytocin to continue to nourish, love, coo at, entertain, and protect her baby. Oxytocin also promotes pro-social behavior by increasing gaze to the eye region of the human face. I assume that eye gaze starts during breastfeeding, and continues to promote social interaction throughout life. 

Scientists studying abuse and childhood neglect found that adults that were raised in orphanages or abused during childhood have lower oxytocin levels. They (and I) believe that the early mother-baby relationship is crucial to oxytocin response and human interaction later in life (thanks for all the oxytocin, Mom!).

Oxytocin also promotes social recognition. In rodents, the ability to recognize and process odors of friends and enemies is enhanced by oxytocin. In humans, it helps us remember and recognize faces (way less cool, but hey, probably way more pleasant!). This aspect of oxytocin is crucial to creating and maintaining friendships and relationships. Oxytocin also regulates social memories, displays of friendly as well as aggressive behaviors, and by reducing stress hormones, allows us to trust the faces we see frequently. 

While this is awesome, and a great benefit of oxytocin, we need to be careful. These effects cause us to trust people more readily (on oxytocin, study participants will give strangers more money - generosity hormone?), which could result in being taken advantage of (in any kind of relationship).

For you animal lovers out there, oxytocin levels are also increased in people reporting strong bonds between themselves and their dogs. Annnnnd oxytocin is released when petting animals! 

2. Oxytocin reduces anxiety, fear and stress

When stimulated by positive social interactions (like hugs, hand-holding, cuddling, or smiles), oxytocin calms down the amygdala, reducing fear and anxiety and creating emotional connections. So if you find yourself in a stressful social situation, oxytocin might help you out and calm your nerves. Oxytocin has also been found to reduce levels of cortisol and ACTH - hormones associated with stress.
 

3. Wound healing and oxytocin.

Cortisol inhibits wound healing, and because oxytocin lowers cortisol levels, it may improve wound healing and inflammation. There were a couple of animal studies that showed that paired animals or animals given oxytocin had improved wound healing. And in humans, pain perception is decreased in people with higher oxytocin levels! This effect of oxytocin may be able to explain the health benefits of certain therapies such as massage, aromatherapy, art therapy, and meditation!

4. Love, sex, relationships, & oxytocin. (Why I am posting this on Valentine's Day)

I'm pretty sure my oxytocin levels spiked when I saw this!

Like I said before, this aspect of oxytocin is why I became obsessed. Here is a bit of the Valentine's Day appropriate side of oxytocin...

Love: Animal studies of oxytocin are often done on vole rats - monogamous rats that form long-term bonds and are bi-parental (AKA rats that make bonds the same way we do!). Giving vole rats oxytocin enhanced bonds between the vole rat couples, and giving vole rats oxytocin antagonists disrupted those bonds. One of my oxytocin bloggers (yeah, I have those) wonder if people who cheat on their partners have lower levels of oxytocin than the strictly monogamous... hm...

Oxytocin is partially in charge of partner preference (by way of odor in animals or facial recognition in us), and increases during intense romantic attachment. The "euphoric" feeling of a new relationship is related to higher oxytocin levels (higher than longer relationships in fact). But as the relationship continues every touch, kiss, caress, or sexual experience with someone releases some oxytocin, enhancing trust and increasing the subconscious bond between the two people involved. I think that oxytocin is a key to maintaining a successful relationship by reliving that "euphoria" of a new relationship.

Oxytocin is also released during relationship problems and when relationships end. I like to think of it as craving for something you can no longer have. There is a downside to everything, even oxytocin. But cuddling with a pet, dancing, painting, getting a massage, or getting support from friends (oxytocin releasing activities!) can help alleviate those cravings and partially "cure" the break-up blues! 

Sex: The biggest rush of oxytocin is released during arousal in men and women, peaking at orgasm. Levels go back to pre-arousal levels about thirty minutes later. This hit of oxytocin is akin to a high from ecstacy. In fact, oxytocin activates the same (dopamine) receptors that addictive drugs do, encouraging us to go back for more! 

In male animals, oxytocin increases number of erections (only if testosterone is also present) and decreases time between "mountings." However, at very high levels, the opposite occurs and the male exhibits "sexual satiety" - increased non-sexual attention to the female (post-coital cuddling!). 

Women vs. Men: Women have more oxytocin receptors in their body, and express more oxytocin than men (gives us those fab maternal instincts). Also, oxytocin gene promotors contain estrogen response elements so that estrogen actively encourages oxytocin to hang around in our (female) bodies. I like to think this is why women tend to become more attached to their partners during new relationships than men. I also think it can explain some discrepancies between the way males and females act in relationships and during partner bonding... (I could go on and on about this...)

I have a ton of other theories about how the Valentiney actions of oxytocin explain the relationships I have been in or relationships I have heard about from friends. Because I don't have time, many of you have heard them, and my theories are just theories, I'll stop there with this topic...

5. Oxytocin as a cure.

Patients with schizophrenia have low oxytocin levels in their cerebrospinal fluid (CSF), and scientists think that their dysfunction in gaze and facial emotion processing is related to low oxytocin levels. Animals treated with PCP have similar behavior to schizophrenics, and oxytocin restored their social behavior.

Depression, post-traumatic stress disorder, and OCD also seem to be related to low oxytocin levels. SSRIs (antidepressants) were found to cause a short-term increase in oxytocin in rats. Maybe oxytocin can treat depression?

 
Oxytocin also might decrease blood pressure, reduce body salt content, and act as a pain-killer. Studies are currently being done on the possible uses of oxytocin for fibromyalgia for pain. 

Oxytocin is also being tested as a treatment for sexual dysfunction in both men and women. 

Children with autism, a developmental disorder characterized by decreased social and communication skills, have lower oxytocin levels and higher oxytocin precursor levels. Maybe an enzyme that makes oxytocin is defective? Children with autism are also more likely to have a certain haplotype of oxytocin receptor. In a small study of 15 adults with autism or Aspberger's, IV oxytocin improved social recognition and speech comprehension, and reduced repetitive behavior in autistic patients. Obviously more research should be done, but it seems that oxytocin is somehow involved in autism, and has the potential to be an amazing treatment.

CONCLUSION: 
To sum everything up, oxytocin does a lot of stuff and is super duper awesome and obsession-worthy. I hope you learned a thing or five, and that you now find oxytocin as neat as I do! Feel free to comment with questions or arguments or theories, and I will keep my readers (you) posted on new oxytocin news as I hear it. 

Sources: (I love having access to Journals!)

1.) www.oxytocincentral.com

2.) Waguih, W. I., Kahloon, M., Fakhry, Hala. (2011). Oxytocin role in enhancing well-being: A literature review. Journal of Affective Disorders, 130, 1-9.

3.) Heon-Jin, L. Macbeth, A.H., Pagani, J.H., Young, W.S. (2009) Oxytocin: The great facilitator of life. Progress in Neurobiology, 88, 127-151.

Lisa's Lessons of Late

I have learned some crazy and random things the past few weeks. So I decided to share...

1. Onset of puberty is SUPER YOUNG.
Boys start puberty at age 9, and girls between 7 and 8. I don't know about you, but that's a lot younger than I remember starting puberty. The onset of puberty has been decreasing in the past 175 years and scientists don't know why. I've heard people claim that it's related to environmental toxins, I've even heard the blame land on genetically modified foods. Who knows what is to blame, but puberty starts early!

2. Breastfeeding guidelines.
So people who hate on public breast-feeders are just hating on good moms, because babies should be breastfed 8 to 12 times a day for ten to fifteen minutes per breast. Do the math, that's up to 6 hours a day of breastfeeding. If moms don't want to breastfeed in public, then they better do errands quickly and stay home all the time, because they should be breastfeeding every 1.5 to 3 hours.

**Public Health Note: Breastfeeding is really good for babies, and should not be replaced with formula feeding! It gives babies an immune boost, feelings of warmth and love from mom, and has all the nutrients a baby needs for the first 4 to 6 months of life!

3. The origin of the word hypochondriac.
We are learning about the abdomen, and when we discuss the different structures, we refer to 9 regions created by what looks like a tick-tack-toe board on the abdomen (see photo on left). The "hypochondriac regions" lie beneath, or "hypo," to the cartillage, or "chondriac," of the ribs. In ancient medicine, patients would often come to their doctors with pains in the hypochondriac regions. Sadly for those ancient hypochondriacs, the doctors believed that those regions held anxiety and melancholy, and dismissed the patients even though they may have had serious problems. Today, people who claim that they have bundles of medical problems without any clinically observable information to back it up are still called hypochondriacs.

**Public Health Note II (I know, again): I wonder if current doctors are making the same mistakes their predecessors did by dismissing patients with problems that they can't find answers to.

4. Most of the world is lactose intolerant after early stages of development:
My professor seemed to think that people drinking milk that is not from their mother is a really weird and crazy concept. Some Caucasian groups of people gained the gene for lactose tolerance and were able to survive better with food available somewhere during evolution. So people here are often lactose tolerant, but in most parts of the world, they are not.

As my professor said, "So if you are lactose intolerant, you do not have a disease, you are not a genetic freak. You are normal. Most animals cannot drink milk past an early age, most humans can't drink milk past early stages of development."

On Being Hectic

Two summers ago, Frannie and I spent five weeks in Europe traveling around with a bunch of twenty-somethings on a bus. We met a girl named Kate from Australia and I was fascinated by how many words she used differently than I did. One such word was "hectic." We went out dancing, and at the end of the night she said "tonight was heaps hectic!" I had always considered the word to hold a negative connotation. I would use it to complain about busy and stressful days when nothing went my way. Kate used to word to mean something completely different. Kate meant "tonight was super awesome!"

Lets rewind a little bit. In college, I overextended myself and was involved in literally as many things as I could fit on my plate. Most of the time I was happy with my busy schedule, and whenever I did find fee time I would ended up picking up projects or finding things to do with every minute of my day.

After applying to medical school I decided that I needed a break. I felt like I was always busy and hectic, so I deferred from Tufts for a year. I took up a 9 to 5 volunteer job as an Americorps VISTA in the Service Learning Department of Anne Arundel County Public Schools. After work, I would go home for four to five hours of free time.

What did I learn during my year off? I don't like free time. Now don't get me wrong, I need about an hour or two a day to unwind, relax, cook dinner, maybe watch a tv show, etc, but too much free time is not for me. My AmeriCorps position did not keep me occupied, so I picked up projects and activities to fill my time. I still found that I had too much free time.

So this week was "heaps hectic," both in my meaning and the Aussie meaning of the word. I was busy, stressed out and overwhelmed from 8am in the morning until 1am the next day. But looking back, I had a spectacular week and I learned and accomplished so many things.

I may complain and whine about how stressful my life is and how much I have to do, but last year proved to me that I wouldn't have it any other way. When I get too much free time, I automatically fill it. My friend Alex always used to stop me when I complained to tell me that I asked for my busy life, and she's right. I need to remind myself that this on stressful weeks like this week, and change my concept of the word hectic. I may be busy, but for me, busy is super awesome, heaps hectic!

So I know I'll regret this, but when I complain about how hectic everything is, remind me that that I like hectic. 

*Disclaimer: I don't mean to say that a hectic (busy + awesome) life is always a healthy life - I constantly work on finding a good balance between my personal preference for a busy life with enough free time to remain sane. I just wanted to explain why I often overload myself with extracurriculars and activities. Definitely something I need to continue to work on!

How to Breathe

Nope, not a sappy love song** written by Taylor Swift or the like, but actually how we breathe! We learned this in class and I felt it was blog worthy:

The brain has parts. One of the parts is called the medulla. To keep things simple, part of the medulla  makes us breathe by ramping up a signal and then makes us exhale by stopping the signal for 3 seconds. Repeat forever until death. Cool. But cooler than that, the medulla has a lot of inputs to tell it to change the way we breathe. Here is an example:

In our nasal mucosa, or as I like to call it, nosehole, we have nerve endings that sometimes get irritated. These nerve endings are sensitive to different gases, smoke, perfumes, and even cold air. When they get irritated, they produce chemicals and send info back up to the medulla. The medulla then tells the lungs to take a deep breath, hold it, and then VIOLENTLY EXPEL all of the pressurized gas, and hopefully the irritants along with it. ACHEW! That's right, that's why we sneeze.

Ok maybe I'm the only one who thinks sneezing is cool, but I had a cold last week and sneezing was pretty relevant. On a public health side - sneezing is gross, and it may expel irritants but it's spreading those irritants along with viral particles (including the common cold) around so other people can catch them. Not cute. So make sure to catch those sneezes in your cubital fossa - or as I like to call it, elbow pit!

**On another note, and to sound like another sappy love song, I held a heart in my hand today. Learning the heart has been fun, but physiology of the heart and lungs reminds me a lot of physics - not my strongest subject. 

But Thursday I finally get to break out my brand new stethoscope and listen to some heart sounds / learn how to take a blood pressure. Woot!

Doctors That Suck and Perfect Patient Populations

My classmates and I recently had a discussion about how all doctors suck. Then we decided to make a pact that we wouldn't suck when we were doctors, but I had a terrifying realization.

Kind of like with anything else (teachers, celebrities), some people like some doctors, and some people don't like those same doctors. So some (potentially many) of my patients just won't like me.

I never liked being disliked. I guess nobody does, but I mean I reallllly don't like being disliked. I try to be nice and sweet and charming so that people like me, and honestly because there is enough mean, nasty, bad, evil, greedy, and cruel going around in the world that I don't really want to contribute to that pot of words / feelings. But I also like to be honest, and sometimes that can be mistaken for mean / insensitive.

But anyways - how can we, as hopeful future doctors, appease the masses of patients that we see? Obviously we will just have to do our best.

Dr. Altman, one of the primary care docs we see a lot (he also specializes in nutrition, and gave us a lecture that resulted in over half of our class buying natural peanut butter, Kashi Go Lean, and Omega-3 eggs) said that eventually the patients that like you will become your patient population. The people that like you might tell their friends how great of a doctor you are, and their friends will most likely also like you, and the cycle will continue. Conversely, people who don't like you will definitely tell their friends (and even lawyers), and you won't see anyone they know (except maybe their lawyers). Eventually, you will see lots of people that work with your personality.

I will have to wait and see if this is true, and all I can do now is hope that Dr. Altman is right. I have a lot of training left before I actually see patients on my own, and I am sure I will acquire tools that will help me work with different types of patients so that I don't have too many that don't like me. Until then, I guess I need to just do my best, and hope that when I am an actual working doctor, I find my perfect patient population sooner rather than later!

Bad Bloggers Take Big Breaks

And Medical School students get two weeks off for Christmas / New Year's.

But I'm back. With the following random thoughts:

I am so thankful to the man who donated his body to science to allow me to learn. My dissection-mate showed me that he has a depression where his wedding band was and it really broke my heart because he is somewhat young and unlike previous cadavers, looks stunningly alive and healthy. So this post is dedicated to him. And his brachial plexus that I spent 2 hours dissecting and figuring out today (see later thoughts).

Medical school is ludicrously hard. I know that people think that medical school is hard, but I am going to admit, confirm, and even insist that it is true. I don't know how much learning a brain can handle in one day, but medical school pushes my upper limits of daily brain capacity, which causes me to do things like forget birthdays and lose my keys. Just a thought.

Other things are also ludicrously hard. I am in an accounting class and boy did I have trouble doing my assignment. And there are so many things I just don't understand / know. Like all of geography. And most of history. So props to the people in other fields who don't get recognized for how hard their subjects are too.

I am going skiing this weekend with a lot of other medical students. We just studied the legs, and most of the fractures we learned about are most commonly caused by snow/ice activities. I even broke my humerus (upper arm bone) by falling while ice skating. I am a little nervous, and predict at least 1 bone from 1 classmate breaking this weekend. I hope it's not me and my bone.

This is a brachial plexus. It's what allows your entire upper extremity (doc term for arm) to move and sense. Take a look:

 

If you can't see the labels, thank me later. It's like a bunch of merging and splitting highways that all lead to the same five roads. Very confusing. But kind of cool. We dissected it out of the arm today, and it took a long time to find everything.  

I really should get back to reviewing, so that's all for this week!