… and then suddenly the weight lifted off 60 shoulders simultaneously when the last buzzer rang. Anatomy lab ID’s are on a timer (90 seconds per station) so everyone in my group was done at the same time. I guess I hadn’t realized how stressed out I really was, because all of a sudden I could breathe more easily. The mood just… changed.

I mean, I know the pressure of having to constantly perform at such a high level is bad for you. In the past couple weeks I’ve eaten at chipotle roughly 6-7 times (usually we cook), drunk the better part of 2-3 boxes of soda, made coffee every single morning (and gone back for refills)… I mean seriously. You can’t be UP for such long periods of time without coming back down hard. We weren’t meant to sprint for weeks.

Anyway, in other fun news, a good friend of mine has hypothyroidism, and thanks to the HCB that we’ve learned I now know all about goiters and the hormones made by the thyroid gland. Hypothyroidism is one of those gratifying things to diagnose, because you tell someone that there is a single pill that (a) makes you lose weight, (b) makes you more energetic, (c) increases sex drive, and (d) may improve the softness of your hair. Basically, they are miracle pills, full of magical awesomeness drug. If they worked without the patient having hypothyroidism? Why, the inventor of such pills would be sleeping on a mattress stuffed with money. Maybe I should get on that. Mattress made of money. Has a nice ring to it.

It’s pretty sweet though, that just by knowing the hormones a gland makes you can understand (mostly) what is going on when it’s diseased (hypo = too little, hyper = too much). I’ve only been in med school half a semester! I suppose you’ve got to learn all this stuff at some point- I guess I just didn’t figure it would be so soon.

Neuro is tomorrow… I think I’m mostly ready for it (and not as much for anatomy on Thursday). I’m really burnt out though, like I never was for the diagnostic. Yeesh. I’ll be glad when this set of tests is over. Kind of reminds me of the type of studying we did for the MCAT… constant “I can learn more than I know now” kind of thing.

Its funny too, I can’t tell why I’m trying so hard. At this point, I’m pretty sure I’ll pass- so why work myself into the ground? P = MD is what they all say. What’s the point of trying to ace things if you’re going to get there eventually?

I suppose part of it is that I’m no longer studying for the test. I mean, I have to know enough to pass the test, but the test isn’t really the issue here. This is my “professional development” at stake (I’m 22… far too young to have a professional life as far as I’m concerned). This is me being able to look at someone with Bell’s Palsy (not very serious) and be able to tell it apart from a brain tumor (serious). I suppose the stuff that I’m learning now all seems relevant, so I’m loathe to discount part of it and just say that I’ll pass the test. Who knows… maybe I want to go into ENT, and all this anatomy business of pharyngeal constrictors will matter. Maybe I’ll be a shrink and NONE of this will be important. I guess I can’t know at this point.

“Like trying to drink from a fire hose” is what they called it before we started… I think I see what they mean now.

This midterm is hell. Everyone is freaking out. People are getting sick left and right, and fighting through excessive fatigue just to make it through the day. I’m drinking about 3-4 sodas a day and a cup or two of coffee just to stay awake… and that doesn’t include the hour-long nap I usually take when I crash after class.

Maybe it’s not QUITE that bad, but we’re pretty stressed out. I’ve never seen such a snappy, punchy group of people. We’re signed up for roughly 3 times the units it takes to be a full-time college student at the U of A, just to give you an idea of the rough amount of material they are expecting us to take in. At this rate (though I think it slows down after this semester) we’ll have taken 6 years worth of classes in 2.

AAAAAAAAAAAAAAAAAAAAAAAaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Thanks to Neuro, I now know why you get dizzy and nauseous when you get really drunk.

Normally the part of your ear that is responsible for recognizing angular rotation (i.e. quickly looking to the right, left, up, down, etc.) isn’t responsive to gravity. However, when you drink copiously, the fluid in the inner ear becomes less dense… and all of a sudden, gravity makes your ears think that your head is spinning. Note: this doesn’t happen to drunk astronauts.

What’s important about this? If someone is drunk and lying on a couch, complaining that the “room is spinning”, look at their eyes. The eyes will slowly move to one side, and then quickly flick back to the other. Repeat ad nauseum (no pun intended). These eye movements, called nystagmus, are normally responsible for letting you read a road sign when you’re riding in a car. For example, you track the sign slowly with your eyes, and then quickly flick back to a new point of interest.

When you’re drinking, though, it’s what cops use to test if you’re drunk.

Fun party tricks we learn from med school.

So one of my friends broke her foot last night (rolled it while she was walking in flip flops… I guess it doesn’t take much to break a foot). Anyway, eventually she realized that it hurt badly enough that she should probably go to the ER, since she was convinced that it was broken.

As the only sober one at the bar, duty fell to me to take her to the ER. Turns out she was right… the fun part, though, was that since we were both medical students, the docs totally came in and chatted with us. Eventually they even took us over to the X-ray station so that we could look at her films. We’re going to try to get a copy of them from the radiology department and put them up on the X-ray viewers in anatomy lab so that everyone can see what she did to herself.

Good times, I tell ya. It doesn’t hurt that her father is the head of the ER there so we got in and out in about an hour and a half. Nepotism at its finest.

Also, I’m starting to get really familiar with upper extremity, head and neck anatomy. I realized today that I know exactly why shingles present the way that they do… without any sort of pathology lecture. They basically follow a nerve out of the spinal cord and so you get an excessively painful rash showing up wherever that nerve goes on the body. Why are they so painful, you might ask? Those just so happen to be the nerves that carry ALL the pain fibers for the area… so it hurts.

Anyway, I’m feeling like I’ve got more of a groundwork for all of the illnesses and stuff we’ll learn later on in our training- and that’s really exciting. Midterms are in a week… each test is 4 hours long. Bring it, med school. Bring it.

So I split a head down the middle with a hacksaw a couple days ago.

…

I guess it shows how desensitized we’re getting that by far the grossest part for me was the mucous in the nose, though pulling out his dentures so we wouldn’t break the saw was pretty wierd too. He’s got 3 gold teeth.

Before I head off to school, I gotta say (again) this has gotta stop. I woke up last night to realize that I was dreaming about studying where the abducent nerve was. I’ve heard that you dream about whatever happens to you during the day… does that mean that I’m doomed to have anatomy and disease knock about in my head 24/7 for the next 4 years? I didn’t sign up for this.

By the way- interestingly enough, I had the right locations for the nerve in the dream. It wasn’t one of those crazy ones where you can’t figure anything out… I think I was actually studying it. I suppose congrats are in order to me for finding new and innovative ways of using my time?

I’m sleeping badly. I got up in the middle of the night to go to the bathroom, and I realized that I had been dreaming about the cranial nerves.

This happens routinely.

In my last post I mentioned that med school has taken me out of my comfort zone more than I ever have been before. I realized today that it is clearly doing the same for my classmates.

Example. One of the people in my interview group (for the sake of anonymity, lets make this person a girl named Prudence) was just totally blown away today. Prudence, you see, is a very christian, conservative girl who enjoys sex with her monogamous boyfriend of a couple years. She almost always uses condoms. She drinks at parties, but nothing too serious. This, by the way, is the box that I’m putting her in. It might not be entirely fair, but from what I can tell it’s a pretty accurate representation. My point is that in her own little world, she’s basically doing everything right, and things are good.

So. We were at the local public health clinic today doing the high risk interview (see the post below). Prudence and I had two patients- she interviewed the first, and I did the second. Her patient was a man who drinks 6 days a week, snorts coke 2-3 times a week, and has had over 100 male sexual partners in the last 3 months. He’s HIV+, Hep C+, and who knows what else. My patient was a female sex worker who 3 months ago finally managed to kick her heroin habit, thanks to daily cocktails of methodone. She’ll have sex with anything that pays, in any way, shape, or form. She’s been running her practice out of her house since she was 15. It costs more if her client doesn’t want to use a condom (which surprisingly, most are willing to use). She also has a routine partner who also turns tricks (he, by the way, does not identify himself as gay… but the price is right as a male prostitute). They don’t use protection when they sleep together.

These people, by the way, keep quite the company. Though today was a relatively quiet day, there is normally a 2 hour wait to be seen- and the people in the waiting room run the gamut from wealthy doctors to rural farmers to 13-year old girls coming with questions about their 27-year old boyfriends.

It was interesting to see just how sheltered Prudence really was. She barely realized that people catch STDs from oral sex, thinks that Bush’s abstinence only education policy is working just great (let them know that God hates premarital sex and it’ll work, right?), didn’t know that people get their genitalia peirced, or that people in monogamous relationships will sometimes have routine partners on the side. The list goes on and on. The social workers were so down-to-earth and matter-of-fact about all of this stuff… and with every new fact, her eyes opened a bit wider. It was amazing to see.

And this is not to say that I wasn’t surprised too. I think my jaw probably dropped when Julie (my patient) told me right off the bat that she had been a sex worker for the last 30 years. But I’m familiar with the knowledge that these things happen. Prudence… well, Prudence had a very novel experience. Reality just invaded her personal space in a very real, very “I-have-Hep-C-and-you’re-sitting-2-feet-from-me” type way.

There will be a lot of other things like this for me in the future. I’ll learn about diabetes and know that the treatment is tight regulation of insulin and careful monitoring of blood sugar levels. Then I’ll run into a patient who is a noncompliant diabetic (because diabetes doesn’t HURT… so you’re less likely to care for it) and doesn’t take care of their disease. And it will shake me out of my perfect world where everyone is treated, is healthy, and behaves like they’re supposed to. I guess I’m kind of excited to see the real world clash with my expectations of how it should be.

By the way, something is wrong in a state where prostitutes are arrested by police if they have 5 or more condoms on them at a time. If they have 5, they are considered to be “actively hooking” and are taken in. It’s ok for them to be walking around without any condoms at all, spreading HIV and who knows what else… but god forbid they have condoms with them. Treat the symptom, not the problem. I think we do that way too often in America. We’ll cover a quadruple heart bypass through insurance… but not a visit to the dietician beforehand. Pregnancy… but not contraception. We’re too reactive.

Its funny, I feel like medical school is making me do more things outside of my comfort zone wayyyyyy more often than I ever had to in the past. Tomorrow we’re doing the “high risk behaviors” interview at an HIV clinic here in town. I get to ask about whether or not you:

1) Have unprotected sex all the time (vaginal, oral, anal)
2) Do drugs
3) Smoke
4) Have a drinking problem
5) Have multiple partners (see 1)
6) Own guns (you’d think it would be an odd question to ask, but it is considered a “high risk behavior” due to the fact that houses with guns in them
statistically have many more injuries than non-gun households… especially to little children)
7) Eat “normal” amounts of food
8) Work in a place that may have harmed your health in the past (asbestos removal, anyone?)

Now I ask… how do you ask someone these questions without ever having met them before in your life? “Hi, my name is Zac, I’m a medical student with the U of A, and I’d like to ask you a few questions about potential risk factors to your health…. if you don’t mind, I’ll just dive right in with #1!” Think about how dehumanizing some of these questions are… and then think about asking them over and over and over again until they just become another tick on a chart somewhere. IV drug user, 45 years old, multiple partners. High risk for STDs. That’s what you’ve become.

I mean, seriously. These are not easy, normal things to ask. I’m also 22 years old. Imagine that you’re an older person who is being seen by a doctor. You expect to see someone who is competent, serious, and professional- not some punk upstart 22 year old kid who’s asking you about your sex life. Granted I’ll be 26 by the time I’m actually an M.D., but the point is, I’m still young, and I FEEL it. It’s not that I want to be older, it’s that I’m realizing that youth is going to work against me at this point in my life.

Also, I feel kind of behind in school. I just haven’t been able to motivate lately, and somehow the material that we’re learning now (and it’s still just anatomy, basically… it’s mostly muscles, nerves, arteries, and veins and their actions and locations) is more complicated. Granted, we’re doing head and neck anatomy. It’s really, really fascinating stuff, but it’s so phenomenally complex its just really hard to wrap your head around it often.

Why, you may ask?

Well, if you think about it, your arm, for example, gets sensation and motor control from a bunch of nerves that come from your spinal cord. The spinal cord then goes up through your neck and eventually up into your brain. Your legs do the same thing. Now, you also have ALL of the nerves of the face (and there’s 12 of them) and neck that also track back into the brainstem.

Also, all the rest of the organs and such in your body are controlled by MORE nerves (heard of the fight-or-flight system? That’s what we’re talking about here) that then also track up next to the spinal cord… and meet up in the neck.

Finally, think about all of the sensory stuff in your head. Sight, taste, smell, hearing, touch (which, of course, is also present in the rest of the body) all exist in the head. They’ve all got to connect back to the brain somehow too. These are part of those 12 nerves from before.

What this means is that understanding where everything goes in head and neck is roughly akin to, say, ripping out the main powerline to an entire neighborhood and trying to figure out where everything is supposed to go. It’s SO complicated. Oy.

Still, it’s so cool I can’t even begin to describe it. The reason you get a runny nose when you cry? Normally you produce tears all the time as a way of keeping your eyes moist. Your tears then drain into your nose through the two little holes in your eyelid (right next to the nose on the upper and lower eyelids) and if you cry, you overflow and make the inside of your nose wet. Hence the runny nose Nifty, eh?

Anywho, I’m off to study more. Know how when you hit your hand with a hammer you get that sharp first pain, and then the horrible, dull throbbing? That’s because you have 2 types of pain nerves, and the “dull, throbbing pain” ones are slower to send their signal. That’s what I’ll be studying right about……. now.