Ode to First Year Anatomy

I never knew I would one day be dissecting some one's face. Using a scalpel, we made an incision along the midline of the face, before peeling flaps of skin from each side. Once that was done, we began the process of removing the soft yellow fat to identify the facial muscles, nerves, vessels and glands.

It was so odd looking at the face. It was strange. As I made the incision, I did not even flinch. This is not normal, I thought. Just a year ago, I would have been unable to look at our cadever's face. And today, I was actually dissecting a part of the body that is so personal, a reminder that we are working on individuals that each had very different lives.

Have we just become so desensitized? Or is this a sign that we have matured and overcome our initial trepidations associated with confronting issues of death and dying?

Today was the last of first year Anatomy Lab, a milestone in my medical education. We will revisit the anatomy lab during the Life Cycle Block to study the pelvic organs next year. But today really closed the majority of the Anatomy Chapter in our medical education.

I am relieved and excited to move forward, now that I have gained a new perspective and appreciation for the human body. Farewell to the hours in lab spent standing around our body, debating about which structure we were looking at, smelling the formaldehye, wearing the anatomy scrubs and navigating the complex geography of the human body. Anatomy is not completely over; I will return for review before the first exam. But for now, I feel like it's time to move on.

I must express my appreciation to the families that have graciously donated the bodies of their loved ones to help us in our medical education. It is truly an incredible sacrifice and for that I am thankful.

The Return of Pig Feet

The pig feet were back for the OR Skills Review Session. This time around, there was less fumbling with the needle drivers, forceps and sutures. The incision was made and sewed back together with the running sutures and interrupted sutures. The surgeons and residents were on hand to assist us.

We also learned this new subcutaneous suture, which is actually laid below the skin (so there is no way to actually see it; it's pretty cool when you see the black line of the suture disappear under the skin.

At first, it took a little effort to recall the motor skills involved in tying the double hand knot and the steps of suturing. But with some practice, the motor skills returned.

While we sewed pig's feet, the former second year medical students (who are know third year medical students) embarked on their first day of clerkships. Hard to believe, we'll be there in a year.

As part of OR Assist, I will be in the OR with my surgeon mentor on Wednesday; my mentor is in urology and it will be interesting to learn about a field I have not been exposed to. Hopefully, my skills we be of use.

I wrapped up the day with other first year medical students at the Women in Surgery Dinner, which was held at the Chair of Surgery's residence. Although it was "business casual," the informal setting allowed students to interact with faculty mentors from the department of surgery and from different surgical subspecialities, ask question and gain insight into the field from the experts.

It was rewarding to see the diverse faces in surgery and learn about how women in surgery balance career and family in a demanding job that has been shrouded in so much mystery.
The mentors were on hand to dispel any myths and speak about their experiences, in and out of the OR. For example, one trauma surgeon is passionate about sailing and does so on post-call days. Family is definitely a possibility; a number of surgeons had children. And some relied on using their "support networks" for child-rearing.

The surgeons seemed very passionate about their jobs, which got me thinking about where I see myself at the end of medical school and how my career will affect other parts of my life. Could I be a surgeon? And if I was a surgeon, could I balance a family and all the other non-medical parts of my life, which are so central to my personality (writting, photography, running, exercise, family, friends, etc)? Time will tell, but these are important points to consider as I move forward in my education.

The central message that was echoed by a number of surgeons was clear-- pursue an area of medicine that excites you, whether it is surgery or not surgery. The key is to be happy.

A great message, as we wind up our first year and start looking at our second year...

1/10th of BMB done!

There is something so visually stimulating about a hypertrophied ventricle. It always achieves the "oh-ah" effect when showing the effects of hypertension on the heart. I remember when I first say the massive left ventricle in a gross pathology section back in cardio and how amazed I was at the heart and its ability to compensate for high blood pressure through growing bigger (like any other muscle in your body that is put under stress).

High school students were just as impressed, when they passed the heart around during the pathology station, a part of the Fifth Annual High School Outreach Conference (HSOC), an interprofessional collaboration between UCSF dental, medical, pharmacy, nursing, physical therapy, graduate students and postdoctoral scholars was held at UCSF on Saturday, April 26.

The outreach conference aims to introduce high school students from diverse and underrepresented backgrounds to careers in health care and science. Participants from high school in San Francisco, Oakland and Northern California attended the conference. The conference featured a diverse array of activities, including hands-on demonstrations and workshops organized by UCSF students.

I was on hand to help out at the conference, donning an over sized orange volunteer shirt. It was great fun to talk about the heart and introduce students to medicine, a topic so close to my heart (no pun intended). The conference concluded with our Med Link graduation. First, the usual game, followed by a slide show of the year, closing remarks and reflections and the graduation.

Graduates received stethoscopes as mementos of their experience in Med Link. My mentee was excited, "My parents may think I am changing from politics to medicine," she said.

I am truly amazed at how the year has gone by so fast. I felt like I was meeting my mentee not so long ago and now she has graduated.

***

We are 1/10th of a way through BMB (Brain Block). It was a great weekend.

A group of medical students were participating in "THE GAME," a scavenger hunt that lasted for 24 hours. I was planning to register, until I realized the game was an all night sort of adventure, meaning no sleep. I spent my Saturday on campus at the conference and Med-Link, followed by a BBQ with fellow MSP leaders.

Sunday was catch-up day (like usual) and the trip to Ocean Beach (by foot) to enjoy all 70 degrees of sunshine goodness.

Here's to hoping for days that allow for flip flops as we move to week 2 of BMB.

Brain, Mind and Behavior

You can tell an academic block is going to be good, when all the course directors come together in a huddle at the beginning of the first day and chant "Go Brain, Mind and Behavior."

Our last block of first year has begun. The focus thus far has been neuroanatomy. And we looked at brains in the anatomy lab today. The brains were contained in buckets filled with formaldehyde and phenol. As we scooped the brains out, it felt odd to be holding the brain; a brain that once sat in someones head and controlled someones body.

The anatomy of the brain is definitely the most difficult; it all looks light brown with squiggly lines and some stringy structures that represent cranial nerves. The anatomy does come together with some close examination and assistance from Netter's Anatomy Atlas.

I am looking forward to this block. So far, the topics presented has been interesting and challenging.

We'll see how it goes....

Left VS Right Brain

According to my brain usage profile, I am left-brained and a dominant visual learner. I have yet to figure out what this all means. We start Brain, Mind, and Behavior (BMB), our last block of our first year of medical school tomorrow.

Hard to believe that one week of spring break is rapidly coming to an end. The last moments are the hardest, because that's when you actually start thinking about all the things you had planned to complete and never got around to. You know that mental list that keeps popping up, every time you try to relax and have a good time. And it's also the time when you have to pack your bags and say the good-byes.

I will say that I had a relaxing, restful and amazing break. I did not travel more than the 1.5 hour drive to Davis to my folk's house. I did not get to far. It really does not matter how far you go for vacation; it just matters who you spend your time with. Spending time with family and friends is the best way to spend time, even if it's not on a beach in some far away land.

Looking back on my week of adventures, I could not have asked for a better break; I accomplished the tasks on my "fun" list: working out at the gym every day, kickboxing, lifting weights with my trainer and old workout buddies, running, playing tennis, cooking, eating my mom's foods, spending time with my family and cats, reuniting with old friends, eating out at the 5 different restaurants in Davis, exploring Midtown Sacramento, writing, photographing, attending Picnic Day, sleeping and keeping my mind off medicine (for a change). What a week!

I guess all goods things come to an end. But so fast...

I'll revisit the topic of right vs left-sided brains once BMB starts (tomorrow....)

Just an Interesting Picture

Some colleges pride themselves in having famous athletic teams. As an undergraduate at UCD, I can admit that I never attended a single athletic event, partly because I have a short attention span and because I am pretty apathetic to school athletics. But there is something UCD is unique for- Agriculture and the cows!

How I love cows, horses and barn animals!

Yesterday was spent lying on the UC Davis quad (post-workout), witnessing an annual UCD event- a cow-milking contest, as a preview to Picnic Day.

Pictured above: Cow 1 (Ester, I think was her name), being walked to get milked by the contenters.

Saturday will be Picnic Day, an exciting, fun-filled open-house event at UC Davis. Can't wait to participate in the festivities now that I am an Alum.

It's hard to believe one year has gone by since I decided to head on up to UCSF.

It's nice to know that some traditions (cow milking) continue on and captivate future generations of students.

Masochism Revisited

Last night, I was sitting on the sofa and watching American Idol for the first time this season. As I grabbed for the remote, I realized I had to pull myself with all my strength since sudden movements were painful. My body was aching and sore all over. The pain I was feeling good be classified as self-inflicted, since I have been working out at high intensity for the last few days under the guidance of a good friend and fitness trainer, who I have known since my days as an undergraduate.

"Eisha, you are going to be one of those 70-year old grandmas that runs after her grandchildren. Not a grandma that sits on the bench," she said during our Abs and Back class. As she said this, I held back my laughter as I struggled to get breaths in between each crunch during a four circuit of ab exercises that made my stomach burn. We still had 100 crunches to go.

My trainer and I go way back; I have been taking her classes and she has taught me how to teach fitness classes, including how to cue workouts. She has been my good friend and my inspiration to stay physically active (one look at her tanned sculpted body and you'll know why she is famous body-builder and fitness extraordinare with a contagious passion for teaching and fitness).

After three days of attending her classes, which have included interval/toning (directed bicep work-out), three ab/back conditioning routines, one butt-kicking kickboxing session and one free-weight session (a focused chest workout for the "wonder twins"), I am feeling as sore as ever.

Don't get me wrong, I am no couch potato. In fact, I manage to get into the gym or run outdoors most days of the week. But since starting medical school I do not have the luxury of the 2-3 hours for workouts I had as an undergraduate. I have been mastering the fine art of fitting in 1-1.5 hour workouts in my day (usually in the evening) wherever there is time.

Right now, my muscles are tight, I have to waddle to get around the house and I stumble up the stairs. And despite the pain, I still keep going back. Why is that we willingly subject ourselves to pain?

Does training our bodies through rigorous exercise add up to a form of masochism?

To be exact, masochism can mean any one of the following (definitions from dictionary.com):

1.Psychiatry. the condition in which sexual gratification depends on suffering, physical pain, and humiliation.
2.gratification gained from pain, deprivation, degradation, etc., inflicted or imposed on oneself, either as a result of one's own actions or the actions of others, esp. the tendency to seek this form of gratification.
3.the act of turning one's destructive tendencies inward or upon oneself.
4.the tendency to find pleasure in self-denial, submissiveness, etc.

I think we can relate Definition 2 to my case. I wonder why I have not felt this sore before when I workout on my own. And there is one simple reason: I can not push myself to the level of sensing pain; it's just too difficult, knowing that I have to live with the physical implications (mostly soreness and limited mobility) that comes with an extra 10 bench presses or running another 2 miles or doing another 50 push-ups.

We must be wired to avoid masochism, even in the most mildest forms (intense exercise). I do have my moments of pushing my boundaries, but I usually like to limit the pain.

Having a trainer solves all the problems that come with thinking through our actions; we have someone who can tell us what to do, encourage us and push us through the limitations when place on ourselves. In doing so, we develop strength and redefine our pain threshold (at least that is the goal).

I guess it goes with out saying in the athletic world: "no pain, no gain." I have really begun to wonder if the individual who coined this phrase, was him/herself a masochist, simply spreading his ideology in a terse statement to weed out the emotional response to stress. Who knows?

And how about the saying, "what doesn't kill you makes you stronger." Let's leave analysis of this quote for a future discussion...

I just know I am sore and tired, but will return tomorrow bright and early (8 AM) to get my but kicked in kickboxing. Does that make a masochist? Maybe it does, but at least I'll have a fantastic workout.

Poison Pill

I am trying to catch up the world news and events, as I lay on my parent's blue couch surfing the Internet (thanks to the wifi set-up in our house). I am instantly drawn to a NY Times article titled "Poison Pill" written by Lisa Sanders.

In the diagnosis article, Sanders follows a medical resident as she admits an 81 year-old woman that presents with hypotension, difficulty breathing and a fever. Her labs revealed a drastic decrease in her white blood cells, the cells needed to fight off infections, a condition called "bands."

If you put the three symptoms together- hypotension, fever and bands- you have got a formula for septic shock. Essentially in septic shock, your body is mounting a reaction against some type of invader, it's usually bacterial, viral or something you are allergic to. So, until the culprit is identified, powerful and high dose antibiotics are administered.

In this case, lab tests searching for an infectious agent proved negative. But there was still something that had caused the allergic reaction. A careful patient interview would be the key to revealing the source of her reaction.

The patient had taken quinine, a drug to treat muscle cramps. And although she had taken a small amount, the resident suspected the patient had some sort of previous exposure and allergic reaction to quinine. And she did; she had drank tonic water (which contains a small amount of quinine). Her bloodwork revealed she was, in fact, allergic to quinine.

By relying on the patient's history, the resident was able to piece together the mysterious diagnosis that lead to the discovery of the patient's "poison pill."

Sanders echoes this sentiment by reflecting on the principles of Sir William Osler.

"Sir William Osler, the father of modern medicine, taught his students that the patient’s story will often contain the key to making a diagnosis. It was important advice at the turn of the 20th century, when few diagnostic tools were available. And it is still true, as research shows. Even now, 75 percent of diagnoses are based on the patient’s story alone. 'Listen carefully to the patient,' Osler exhorted. 'They will tell you the diagnosis.' You just have to pay attention."

The lesson here is clear- listen to your patients and you may just find out what you are looking for. I'll be keeping this in mind in the years to come...

A few pictures

A few pictures to sum up my vacation so far...AMAZING! Relaxing! And laid-back. Enjoying the company of family and cats. Chitty Cat pictured above and Baloo cat below.Celebrating my older brother's and cat's birthday (12 days early). Pictured below, scrumptuous carrot cake that melts in your mouth.

Savoring the moments of joy and listlessness in the unseasonable heat. Hopefully, have some meaningful and insightful comments tommorrow.

MS Tourists

Today was one of those days-- a day to remove layers and wear tank tops and flip flops. In my limited months in San Francisco, today felt like the warmest day of all time, a welcome change from the foggy weather San Francisco is known for. A perfect day to venture out of the inner sunset and explore San Francisco.
I finished the exam after two hours. As I bubbled in my answers, I kept counting down (1 question down, 81 to go, up until the end). It's hard to believe we have just finished another block (Metabolism and Nutrition), which leaves one block left in our first year- Brain, Mind, and Behavior. We have one week of spring vacation to fully recuperate and rebuild our glygogen and adipose stores.

I had a good start building up my energy stores right after the exam. A group of 8 exhausted and relieved medical students got together at noon and ventured into the Haight, a historical neighborhood in San Francisco known for its classic history of hippie movements and reform, for a post-exam celebration. The neighborhood struggles to maintains its identity and resist the commercialism and trendy conformism that has pervaded SF.

We made our way, to Ploy II a Thai restaurant, where we got to exchange spring break plans, share a savory meal and reflect on how fast the year has gone by. Lunch was followed by dessert at Holy Gelato, a cute little gelato cafe in the inner sunset.

It is funny how we are surrounded by such an amazing city, and yet we have only scratched the surface in exploring the diverse neighborhoods.

"We get to be tourists, when we are not studying," said my friend. So true. I guess it's easy to remain in the inner sunset and be such a student.

But there is so much to see and the time is really ticking. We collectively decided we have a few things to do before the next block ends, which include the following:

1. A trip to the San Francisco Exploratorium

2. A visit to MOMA

3. Dinner @ Yoshi's (Jazz Cafe)

4. A hike outside SF

5. More runs in Golden Gate Park

There are so many things to do and yet so little time...

Cheers to the end of another block!

Go Time!

The biochem and endocrine disorders are swimming in my head and slowly making their way outside my brain.

With a last minute review (cram) of the hyperlipidemia drugs, I am off to take our Metabolism and Nutrition Final. (Wish me luck!)

It's go time!

In need of ATP

If you have ever studied biochemistry, there are three ubiquitous letters that are scribbled over every pathway you learn. They are A, T and P, which is ATP (Adenosine Triphosphate), our body's energy source. I guess it looks like the image above

3 days, one final, and mastering biochem and endocrine disorders stand between me and my spring break.

I am so ready for spring break. So ready for one week of relaxing at my folk's house, spending time with my family, cooking some good old fashioned Indian food, visiting old friends, running and working out, laying in the sun, watching movies and TV, photographing random things and playing with the two most adorable cats in the world.

I just need to find my center- focus- and study. So much easier said than done.

Time to return on Metabolism and Nutrition, even as I nodd off and fall asleep. ATP is the source of energy we learn about over and over agian. All I know is that, studying has dissipated all my ATP and I am in serious need of replenishing. Have any ATP you can share?

Cheers to the week of Final, and sucking up all my ATP!

Image: "ATP." http://www.accessexcellence.org/RC/VL/GG/ecb/ecb_images/03_32_ATP_and_ADP_cycle.jpg

Hannah Bones

Monday, we cut bones.

Wednesday, we put our bones together to form a skeleton.

We named our skeleton Hannah Bones. Our skeleton was not white; it's bones were colored in all shades of the rainbow.

Our students during our second Med Teach session got creative during the bones activity, coloring the bones all sorts of color. When we assembled our skeleton from the skull to the toes, we made sure to make Hannah Bones bend some joints to do a skeleton dance.

Ah, how I miss the days of coloring. I actually colored the ribs with those big Crayola crayons. I was definitely out of my element, struggling to color in the lines and being outpaced by my students.

During the lesson, we had an opportunity to teach kindergartners about bones and muscles, an exciting lesson that allow students to move their joints, wiggle (to pretend like they had no bones) and play some games (to simulate what it would be like to have no joints). Just think how you would eat or brush your teeth if your arms were completely straight.

Here is something I learned during the development of our lesson. Did you know that humans and giraffes both have the same number of bones in their neck? Guess how many? 7 bones in their necks.

Giraffes obviously have larger bones, which explains the long neck.

Just thought I'd share a cool fact that makes interesting conversation for cocktail parties (feel free to use this one) or in a kindergarten classroom.

E-mail cascades

As I thumb through the dense mechanisms of fatty acid metabolism, I keep thinking about a biochemical cascade, a process where a stimulus triggers a series of events. In lecture we have something similar, but it is a question cascade, where one question triggers a whole cascade of questions. And in my experience as a coordinator of OR Assist, I have experienced e-mail cascades, where I have to send one e-mail, then another e-mail, then another e-mail, and on and on...

We finally had our first class for OR Assist: Clinical Experience today. After a month of planning, e-mailing and coordinating- we got all the participants in one room and put the information out in the open. I presented a short presentation and was surprised when in the middle of the presentation, a classmate said, "thank you for putting this together." After this, the class erupted in a round of applause. Definitely, did not expect that, but really appreciated it.

As one of the coordinators of this new elective, which pairs medical students have completed the OR Skills elective with surgeon faculty mentors, I have been part of surgeon recruitment team and coordinating logistics. Last month was recruitment season, our efforts were poured into e-mailing and contacting surgeons to generate a growing list of surgeons to ensure that every student can be paired with a mentor.

The purpose of this innovative elective is two-fold: provides students exposure to the OR in the their pre-clinical years and to provide a longitudinal mentoring opportunity for students. I am looking forward to participating in OR Assist (outside a coordinator role).

As I continue to explore the different fields in medicine, I know surgery is on my list (along with 10 other things) and participating in OR Assist will help me develop a better understanding of a career in surgery. That is the goal, at least.

So far, we have received a positive response from most surgeons and students. We cast a wide net in recruiting to represent surgeons from all sub-specialities and to enlist all the help we can get.

The next step will be matching (we allowed medical students to rank their top three choices- which was a hot topic of discussion among participants and made for a longer meeting). Next week, will be yet another e-mail cascade on top of the biochemical cascades that need to be reviewed for our final.

Photograph by Harras Z