Study Mania

There is nothing more painful than returning back from a relaxing five-day weekend to face the second midterm on Monday. And then there is reading about pain for tommorrow's lecture, which is only more painful.

I spent the short vacation (a much anticipated hiatus) with my family, enjoying the simple pleasures of life- food, family and sunshine. When I returned to San Francisco on Monday evening, I noticed right away that it's about time to start studying (what's new?). It's odd. I took my syllabus home and had every intent to open the blue binder and review the material at home, and yet I just could not get myself to open the syllabus. Now, it's out in the open, reminding me to get started.



I did get a chance to revisit our Kindergarten students during our third Med Teach Session. We are now on a first name basis; the students actually remembered our names. The topic digestion and nutrition, taking us back to the simpler days of the Metabolism and Nutrition Block.

Today's lesson was whirlwind tour of the digestive tract, beginning in the mouth, going down to the esophagus, stomach, small intestines and large intestines. We started with an activity that involved chewing a saltine cracker for 1-2 minutes without swallowing. Believe me, it is hard to chew without swallowing. But if you do so, you are rewarded with tasting something sweet due to the breakdown of starch into sugar.

Who knew that you could use nylons and tennis ball to mimic peristalsis? The students definitely were amazed to see how long the small intestines really are (when we stretched out the long small intesting rope). And there was my favorite demonstration- the large intestine and ejection of feces; the large intestine was a flexible tube and tennis balls traveled through the tube and popped out at the bottom (just like feces exit the other end). Very exciting and innovative demonstrations!



Our last activity gave students a chance to construct a healthy plate of food, by drawing different vegetables and fruits on a paper plate. The idea is simple-- create a colorful plate and include foods representing the different colors of the rainbow.



It is always great to spend time with our kindergartner students. There is something so refreshing about how children see the world; they have a simplistic view that is not colored by over thinking things and they always seem to be excited about everything.

Now, if only I could find that excitement in me to actually start studying the dense material of the mind for the second BMB midterm.

Let the Study Mania begin!

Seizures, Epilepsy and Birthday Cake

Seizures occur when aggregates of neurons fire excessively, uncontrollably and hypersynchronously. It's kind of like what happens when you are at a restaurant and the waiter brings out the cake to particular table. Everyone at the table starts singing "happy birthday" (hypersynchronously, excessively and uncontrollably). That's just like a partial seizure. And if the rest of the restaurant joins in- you've got a secondarily generalized seizure. See, seizures are not that difficult to understand.
***

Last night was the dress rehearsal. Today, I performed in front of thirty classmates, teaching my first MSP lesson. As one of the sixteen MSP (Medical Scholars Program) teachers, I have the privilege of leading sessions for my classmates this year and for first-year medical students next year, to help reinforce key concepts introduced in lecture and in the syllabus. I develop a handout to accompany my lesson.

Tonight I focused on Seizures and Epilepsy. To open, I dropped my first joke- "get ready for not just an exciting, but a hyperexciting lesson." I think it was funny. At least, I thought it was funny when I said it in my head (which does not say much).

In presenting seizure and epilepsy from a new perspective, I reviewed the basic construct of neuronal networks and factors that determine excitability. To explain how seizures develop, I used the example of a birthday cake being served in a restaurant. It makes sense and was my favorite part of the lesson.

In stepping back from the complicated science and medical terminology, I was able to use a simple example to teach a complex concept and reinforce the salient points that are buried in pages of text and hours of lecture (at least this is my goal and I certainly hope students got the point). I must thank my professor, since he came up with this idea and actually uses the analogy to explain seizures to his patients.

I have taught in the past an undergraduate and it was something that was central to my life. There is certainly a great deal of preparation, rehearsal and energy that goes into designing each lesson. All in all, teaching tonight was truly enjoyable and reinforces my desire to stay in academic medicine.

Returning to the front of the class takes me back and brings me joy. I am looking forward to the lessons to come and teaching first year medical students next year.

Neurosurgery up close

When we walked into the OR, we first noticed the site at the head of the bed. In fact, the patients head was open with the temporalis and skin flaps peeled back.
We were in the OR to observe neurosurgery cases as part of the operating room tours that are offered to first year medical students during the Brain, Mind and Behavior block. The OR tours provide students with a unique view of the brain and surgical approaches to treating a number of neurological conditions.

The temporalis is a muscle that helps in mastication and normally sits on the temples. The muscle was glistening, the red from fresh blood was visible as the surgeon worked in the small space of the skull. He was completing the case by sewing up the dura mater, a layer of connective tissue that covers the brain.

The neurosurgeon skillfully sutured the dura and then moved on to reinsert the piece of skull that had been removed at the beginning of the procedure to gain access to the specific brain region he had worked on. The surgery was being performed to treat an aneurysm of the ophthalmic artery. Aneurysms develop when a blood vessel dilates and balloons out, weakening the walls. With time, such an artery can rupture, bleed and cause death. A surgical intervention is sometimes needed to prevent such complications.

The initial incision was an inverted question mark that was made along the temple. The skull piece was screwed together; a drill was used to create the holes for the screws. Once the skull piece was in place, the muscle could be sutured. The scalp was reattached with the assistance of a special staple gun.

Later, we saw another neurosurgeon remove a meningeoma (typically a benign mass) from the cortex. As we watched the neurosurgeon slowly cut away at mass, I stood in awe, while he remained focused on the small surgical field. We could see the brain exposed, the vascular surface, the gyri and sulci and the pulsations.

Neurosurgery amazes me. Neurosurgeons can cut the skin, pull back the muscles, cut open the skull and gain access to the brain to repair a damaged vessel or remove a tumor. And once the damage is repaired, they can go back and rebuild what had been deconstructed, piece by piece.

Bay to Breakers

1:22:09. My official Bay to Breakers (B2B) time and my first race.

B2B is an annual San Francisco tradition. The 12K (7.26 miles) trans-city race started in 1912 and has become one of the most exciting days of the year. Aside from the running, the race has it owns unique personality- an eclectic combination of costumes and nudity, public revelry and drunkenness, creative floats, amazing views of the city and a non-stop block party.



Interestingly, for the first fifty years of B2B only men were allowed to participate. This policy changed with the revolutions in the seventies and now the race draws thousands of runners and participants.

The race started at the bay bridge right off the Embarcadero at sea level and crisscrossed through downtown. The urban neighborhood quickly changed into the steep hills that make San Francisco famous. By the 2.5 mile mark, we were running up Hayes Street, which took us to the the highest point in the race (after climbing an 11.15% grade hill). And during this ascent, I could feel my muscles tensing and the lactic acid building up. And it seemed like the hill just kept going up higher. At least, there were salmon running downstream present to distract us. But we finally made it to the top.



From the Hayes Street, we ran through the Pan Handle (along Fell Street), which brought us into the Golden Gate Park and into the thick of the fog. From here, we traversed the park until we made it the brakers (Ocean Beach), one of the most beauitful running paths.

I crossed the finish line at Ocean Beach feeling elated and exhausted, glowing from all the sweating, my heart beating out of my chest (at least that's what it felt like). More than anything, I felt pure joy.



There is nothing like finishing your first race and still be able to feel your legs. Thankfully, the distance was not too bad and I am not feeling the soreness just yet. I am just excited to have been able to participate in such a unforgettable race. Most importantly, I can check off one more thing of my "SF to do" list.

Next step- design a costume for next year's Bay to Breaker race and register for a
15K.

I am an official 2008 Breaker as of today!

Heat Wave

I finally got to wear my favorite flip flops today. For some reason, my feet in San Francisco always stay cold. Today was an exception. The sun was shinning and all 94 degrees of heat were beating down on a city that is not accustomed to such high intensity UV rays. It was the perfect day to go to Ocean Beach.

Having grown up in the central valley, the so-called "heat wave," is bearable. In fact, the heat was a welcome change from the fog, wind and chills that are so endemic to San Francisco.
***

The second part of BMB has covered a wide array of topics, including multiple sclerosis, neuropathology, hypnotic drugs and emotions. The lectures on emotions was especially interesting. A world-renowned expert on emotions, presented an approach to read people's faces to determine if people are lying based on subtle facial expressions.

Along with learning the basics of neuropathology and emotions, I also learned the art of the mini mental status exam. During our psychiatry apprenticeship, we had the opportunity to take part in interviewing a patient. The approach to taking a mental history is fundamentally identical to the history of any other disorder, except we focus on the mental health. There is definitely an art to the interview; there are certain questions that need to be asked and certain topics that must be covered.

Most importantly, you must be prepared to handle yourself when you are
processing the information your patient gives you, including patients who are suicidal, delusional, depressed and unresponsive to treatment.

***
I wonder how long the heat wave will persist. Hopefully, the sun will shine this weekend during Bay 2 Breakers, a city-wide run from the Bay Bridge to the Ocean, a total of 7.26 miles. I have registered and am looking forward to this trans-city run, an opportunity to get to know the city up close and personal, in all its glory. More details (and photographs) to come...

1/3 of the way there

The exam marathon ended today, anticlimatically. After a weekend of studying, memeriziing, reviewing, memerizing the things I forgot from the day before (and repeating the cycle a few times over), I finally confronted the first BMB midterm.

To be frank, the written exam was challenging (mostly because the concepts in the neuroanatomy are no cake walk and require lots and lots of exposure) and the anatomy practical was difficult as expected, given how small the nerves are and how similar th brain structures look.

The marathon started at 8 AM and finished at 1:30 PM.

Taking the anatomy lab portion was odd; there were 35 tables lined in a circular formation with opened heads, faces peeled away, exposed facial muscles, scattered skulls and brains--all the pertinent structures we studied in neuroanatomy. What a site. And to realize how desensitized we are to the sites; we have come a long way.

I walked out of the anatomy lab thinking the following:
1. Neuroanatomy is complicated!
2. I will not have to return to anatomy lab until next year in life cycle (no more smelly blue scrub for the rest of the year)
3. Moving your head upside down when staring at cranial nerves will not enhance your view at all; you'll just feel nauseous
2. I felt numb. This numbness was not a result of a cranial nerve or spinal cord lesion, but mind numbness from sheer exhausation of thinking about how we think about things and how we move our bodies and how we respond to our environments.

The material is extremely fascinating; I will always be amazed by the mind. But the subject matter makes for a difficult exam with some particular intricacies that continue to transcend my understanding.

The end of Exam 1 marks the third mark (we are one third of the way through BMB).

There is no break; we just continue with 8 AM class tommorrow, which means reading tonight.

At least the exam is done...

At least it's not sunny

The preparation for the exam continues, grudgingly. There is nothing quite like spending your weekend confined to the library staring out at the city, in all its life and glory, while you scrutinize over all the intricate details of neuroanatomy in all of its complexity.

The course directors have this mantra to describe the mind training needed to learn the information presented in BMB. "Great concentration and great compassion." I can see why the mantra applies; concentration is necessary to scratch the surface of the content and compassion is needed for your self when you feel like you understand the material, only to discover your logic is skewed and you are back to square 1.

Well, the brain studying marathon continues. I dressed appropriately for this extreme mental excercise (gym clothes).

At least it's not sunny, which makes the studying just a little more bearable. Actually, not really.

Brain Mania

One look at the brain, makes you wonder how this wrinkly mass of tissue can be so complex and unusual. The circuitry, anatomy and physiology of the brain is so complicated and yet so fascinating. It's amazing to think how may action potentials are firing as I write this very sentence.

We are officially 1/3 of the way through Brain, Mind and Behavior Block. I would be jumping for joy, except- we have an exam on Monday.

The first portion of the block was front loaded with neuroanatomy (5 anatomy labs) along with complicated spinal tracts that have intricate pathways through the spinal cord, brainstem and cortex. Following the paths can be quite a mental exercise and become even more interesting the moment a lesion is added to the picture. And then there is making sense of all the sensory systems, including the vestibular system (helps in balance), visual system, auditory system and all the other systems that have escaped my short-term memory.

This makes for an exciting, fun-filled weekend (not) of review, relearning, studying and studying so more. I have revisited the anatomy lab and now move towards to plowing through the 366 pages of syllabus and related chapters in the Neuroanatomy text book.

Oh well such is life.

Let the brain mania start!

***Pictured above: Photograph from High School Outreach Conference of a brain during the graduate student demonstration

In the Forest

If a tree falls down in the Forest and no one is there, does the tree actually make a sound?

How would you answer this age-old question?

Before today, I might have actually considered the possibility that a falling tree actually makes a sound even if there is no one there to hear the tree fall. But after today's lecture on the auditory system, I know have a definitive answer.

When we hear something, our auditory system (through a complex set of mechanisms that I will not explain since I am still learning them before Monday's exam) is actually converting the pressure waves transmitted in the air into sound. In essence, sound is actually how the brain perceives (or makes sense of all the seemingly random air waves traveling the in the world around us). The voices we hair, the leaves rustling, the crashing waves, the loud neighbors-- these are sounds produced by the brain.

So, to get back to the question I presented earlier. If the tree falls down, there will be pressure waves in the air. But will there be sound? Remember, a brain in necessary to produce sound. If no one is there, there is no brain.

As such, the tree will fall in this deserted forest and make no sound.

Enough said.

Revisit Weekend Revisited

I can check off visiting the de Young Museum from my "to do" list of sites I need to see in San Francisco. After running by this museum so many times, I finally entered inside to view the fine art that is housed in the walls of this architectural spectacle. My entry into de Young was part of an unofficial museum tour. I was elected to be tour guide of a group 11 prospective UCSF medical students by virtue of being a current first year medical student, essentially by default.

This weekend is the Accepted Students Weekend at UCSF for prospective medical students. It's the weekend where we sell the school and everything it has to offer. Funny thing, I'm not really sure how much selling has to be done. In speaking with most prospective students, it seemed like they were set on joining us in the fall.

Anyhow, the weekend has been filled with a number of diverse festivities, everything from the structured talks from the administration, an activity tour and my favorite talk about the "agony of making a decision, when all the choices are so good" and then the afternoon activities (take your pick- hike to Land's End, Kickball in Golden Gate Park, Tour de Embarcadero, de Young Musuem).

I spent a got chunk of the early afternoon tabling for the Surgery Interest Group. We actually taught some students how to tie two-handed knots.

I was originally part of the Kickball Game (takes me back to the days of second grade) in Golden Gate Park. But within twenty minutes of the first game, it was clear kickball was not as appealing to everyone. So, I led a group through the park to the museum. Although the art is pretty impressive, I spent more time interacting with the prospective students, who are quite outstanding individuals. In fact, it was interesting to see that my blog has been picked up by some. Sometimes I forget that are actually people reading my entries.

Funny thing, it feels like I was just attending my Revisit Weekend one year ago. Where did the year really go? In one year, we'll be starting clerkships. It's strange. There are currently no second years, since they have transitioned to their third year rotations and disappeared completely. And soon the fourth years will graduate. Wow, talk about change! And the cycle will start soon for another 150 students.

I also had the privilege of hosting an Inner Sunset Dinner at one of my favorite restaurants, Naan N' Curry. Dinner lasted over two hours, with some tasty Indian Food, good times, and the usual ice breakers and the introductions along with a scrumptuous tart to top off the dinner.

At then there was the post-dinner after-party gathering, which was quite the social mixer.

In the end, I certainly hope the weekend was informative and useful for prospective students, who will need to make a final decision within two weeks. I know that the after attending UCSF's Revisit Weekend I was sold and set on attending UCSF. And here I am, revisiting my Revisit Weekend.