25% of an MD

Yesterday, I was staring at the ocean, thinking about how beautiful the water looked and how I longed to be anywhere but the library. I was thinking about the old saying- "there is always light at the end of the tunnel." This may be true, but the creator of this saying did not realize that some tunnels are longer than others. And the tunnel that takes one through studying for the BMB final, is a really long one. At least now, I can see the light.

It's hard to believe that I am one quarter of a doctor. Ok, I say this preemptively contingent on passing our BMB cumulative final.

I will savor the moment and the feeling of being DONE! We are officially second year medical students, popularly know as MS2s, which means the expectation bar has just gotten so much higher. We can no longer use the excuse that "we are just first years..."

When I turned in my final to the BMB course directors, I realized that this is it. They looked at me, and said "Congratulations." It took me a second to register that they were referring to be being done with the first year of medical student.

There is something fulfilling of transitioning from being a first year medical student to a second year medical student. Although, I have yet to figure out what it really is. In this moment, I am just looking forward to 8 weeks of class-free days. Time to recollect myself and tend to the long list of things to do in San Francisco.

Just about a year ago, I was donning a black gown and square hat, during my college graduation, leaping away from college and inching towards medical school. I remember how excited I was to start medical school. There was the joy of venturing to a new city and a new life, a life that would allow me meet so many unique individuals and to live my lifelong dream of serving patients.

I had no idea what to expect. I was bright-eyed and ready to do most anything (ok not really). I was most looking forward to learning my patients stories and helping them as they coped with their medical conditions; I was excited about learning and becoming versed in all the common acronyms endemic to medical jargon. I was hopeful that I could touch my patients lives.

As I sit here reflecting and thinking back to a time not so long ago, I realize that the first year of medical has been unforgettable, surpassing my initial expectations. I have been humbled by being allowed to enter my patients lives in a whole new way, whether it be taking a medical history, performing a physical exam or assisting in a operation. I have been immersed in a unique learning experience that has taken me to new depths; I have surprised myself and seen myself grow, as I confront the social and cultural complexities of medicine.

I have been privileged to navigate the geography of the human body in anatomy lab, dissecting away skin, fascia and muscles to better view the organs of the body of our donor, who we know nothing about. I have learned so much and forgotten most of what was presented in lecture, but I do remember the patients I have worked with away and walk away with a deeper appreciation for the complexity of the human body, in all its strength and fragility. With a better understanding of the human body, I am poised to embark on the next stage of my medical school journey- working with patients and making medical diagnosis.



In less than a year (April 28, 2009), we will transition to the clerkships. I still struggle to translate my patent's chief complaint, history of present illness and symptoms into a diagnosis. The second year will hopefully allow me to better master this nebulous art. Time will tell...

With the first year pocketed away (pending no e-mail from the course directors), I will now attend to some MS 1 wrap-up activities. Here are the things I need to do:

1. Wash my white coat (it's getting a little dusty and the pockets are bulging, so I might need to purge some of the useless papers that have made residence in the pockets)
2. Bury the MS 1 syllabus somewhere in my closet (I won't be looking at these for some time)
3. Change my e-mail signature from Eisha Z, MS 1 to Eisha Z, MS 2
4. Clean my room (and apartment)
5. Write out my summer to do list.
6. Proceed to completing things on my San Francisco "to do" list (it's a long, ambitious list that mostly is concerned with visiting different neighborhoods, hiking, visiting museums, eating at specific restaurants, spending time with my friends, running, swimming, learning to surf, and the list goes on and on...)

I am looking to forward to the summer vacation. Albeit, it's not a vacation in the traditional sense; I will be sticking around San Francisco and completing a research project and curriculum.

In looking back to my first year, I have really enjoyed writing in this blog; I have no idea who reads this and what others think about me and my path in medicine. I certainly hope I have been able to share my thoughts and reflections to give others a closer view of medicine, as I begin to see medicine. Most importantly, I hope you have enjoyed reading and gained something. I look forward to continue writing (I need to update my profile to reflect that I am a second year medical student). If you stay tuned, you will invariably see some of my latest photographs, hear about my work and life.

For now, I am going to cease the day, knowing that I am 25% of the way to becoming a doctoring! Wow!

2 Days to go

Today is the first day of summer. Everyone seems to be on summer vacation. Even the library has instituted summer hours (closing @ 7 PM).

I'm not quite feeling the summer vacation vibe yet. I am still counting down days to the end of BMB. Less than 2 days ago.

It's another sunny and warm day in SF and another day staring out the window, surrounded by my best study friends (laptop, colored pens, highligthers, piles of notes, handful of drug tables (that I'll need to memerize at some time, hopefully soon), the syllabus and Neuroanatomy text book). My human friends have been telling me that I am spending way to much time around these guys.

It's coming down to the homestretch and I am sure my brain is spilling information as I sit here.

The exam marathon study homestretch has begun (and it feels I still have so much to cover and understand)! It's the point in the race, when you feel like your body is going to give up due to sheer exhausation and pain from having run the previous distance, or the feeling that comes when you are looking up at the bottom of a really steep hill right before you start running the incline, when you know your muscles are completely done before you even start.

I'm at that mental point, realizing that although there is so much to get through, there is hope that this shall end and I will be done (soon)! Just like the runner, who is motivated to cross the finish, I am inching forward through the massive amount of information to finish the first year of medical school.

2 days to go (and lots of studying and reviewing to go)!

The View from the Inside

I am just 3 days shy of being finished with my first year of medical school. As I sit here, studying (obviously), I can not help but note that today must be one of the clearest days in San Francisco. From my Fifth Floor seat in the library, I can see the ocean as it hugs the horizon, the water shimmering like little sparkles and zig zags.

The sun is shining, covering the city and adjacent neighborhood in a blanket of warmth. I can feel the heat radiating from the large window that stands between me, the table and the entire world outside. How I want to be outside, running to the ocean or laying the sun or sipping a cup of tea at some corner cafe.

Today was a medical school milestone. We had our last day of class today. Sitting from the back row, I just realized that in less than a year- we will all be scattered throughout the wards, taking care of patients. The days of academic instruction and the days of savoring my classmate's company are numbered...



To celebrate the end of BMB, the course directors awarded the case of day winners, who submitted the most correct responses to cases that were presented at 8:05 AM every morning. The winners received yellow authentic BMB shirts. And in the spirit of the Olympics, the 1st, 2nd and 3rd place winners got to stand on podiums. And to culminate, we all sang the star-spangled banner (I am not sure where this fits in celebrating).

It's hard to believe we have come this far (and it feels like we have just scratched the surface). Studying for this BMB final is just more thing to do on a long list that will follow us through the next few years. I am exhausted, overwhelmed and wondering how I will fit all this information in my already-full brain? We'll see if I can get creative with studying somehow as I brace for a weekend study marathon.

Back to staring out the window...

Less than 3 days to go!

Page 1027

With some difficulty staying awake and some nodding off, I just read the last page of our BMB syllabus. I have officially finished the 1027th page of our massive syllabus.

The last sentence appropriately ties together the theme of the first year of medical school: "Physicians (in their positions of power influence and authority) are ideally situated to not only ease suffering but to assist their patients in moving beyond and above the painful challenges life has given them" (BMB Syllabus, pg 1027).

Now the challenge is understanding, synthesizing and internalizing the complex concepts threaded through the Brain, Mind and Behavior portions of the course. The picture is hazy with pieces scattered in my mind, power points slides, paragraphs in the syllabus, hand written notes and in the last tiny crevices in my brain.

I must now identify the salient pieces and somehow connect them to create a picture that captures the essence of the block.

With 4 days to go, hopefully this picture gets clear soon!

The Countdown has Begun!!!

According to the countdown posted on my facebook page, there are 7 days and 16 hours (as I write this) standing between me and the end of the first year of medical school. Along with getting through this upcoming week of lectures, neurology apprenticeship, anesthesia simulator session, MSP, neuorpsychological small group and all the exam reviews sessions, I also need to pencil in time to study for the upcoming BMB cumulative final.

This last week was somewhat momentous. We had our first doctoring final, with mystery patients who presented with actual conditions. We had to perform different parts of the physical exam and reveal our findings; I performed the abdominal exam and the neurological exam. According to the director, the purpose of the exam was not to test us, but to make us realize how much we have learned since starting not so long ago.

We have certainly come along way. We are still completing checklists, but we have better insight into the purpose of why we do the things we do. The motions of palpating or percussing the abdominal are so much natural and less robotic. "I could tell that you were using your hands to feel for anything abnormal," my patient told me, after I completed abdominal exam.



We also had our last small essential core group session for the year. We ended with a neurogenetics session and a group picture. And we made our final trip to the Marena to visit our preceptor's office. We bid farewell to Honcho (the office dog), inflammed noses (purple on the inside) and allergy medicine.

It is odd. Whenever we plan bonfires, the days leading up to the weekend are sunny and warm and then all of a sudden the fogs rolls in on the day of the bonfire. That is San Francisco weather for you- unpredictable and bipolar at times. My friends were talking about this on Saturday as a group of us huddled close to keep ourselves warm during a bonfire at Ocean Beach.

Time with my friends and the bonfire, with all its warmth and glow, was exactly what I needed before I descend into the vortex of studying with limited social interaction. My favorite part of bonfires is definitely the smores, the perfect combination of crunchy (graham cracker), melted (chocolate) and gooey (marshmallow).



I have to admit, this weekend has been unproductive when it comes to studying, or perhaps I need to set more realistic expectations. There is just so much information. Going back to Day 1 of BMB, recalling all the intricacies of the neuroanatomy and all neural circuitry is going to take some work. It's hard enought to recall the information I learned last week. It's going to be that more challenging to relearn the massive amount of information that has invariably escaped my short term memory stores.

It can be discouraging studying at times (kind of feels like the image below). But I know this will pass...and what awaits us at the end is 2 months of summer vacation. Well a pseudo-vacation (I'll be doing research).



Cheers to the last week of BMB (the last full week of MS 1). It's amazing how in 7 days I will be 25% done with medical school, in what feels like a blink of an eye.

The Countdown has officially begun!!!

Weekend Joys

There is always a calm before the storm.

After a 14-hr lecture week and the second midterm on Monday, we finally got to celebrate the end of the second part of BMB.

With 15 days and a cumulative final exam, standing between us and the end of our first year medical school, I am going to savor this weekend before I begin studying and reviewing all the complex concepts (we were supposed to have learned by now).



Since the start of medical school, I have been anxiously awaiting the Sex and City Movie release. To celebrate the end of our second exam, friends and love (as described by the hopeless romantic), a group of us went to Union Square and finally got our share of Carrie, Samantha, Miranda and Charlotte last night along with a trip to the Cheesecake Factory in Union Square (one more thing I can cross of my "SF To do" list).

I also made my way to Land's End by way of foot during my Saturday morning run and finally got to see Juno, a movie with some of the best quotes of all time.

I am looking forward to spending some much needed time with my closest friends and catching up, while I have a chance. And maybe studying...

In Memoriam

Yesterday, we gathered to honor the memory of the individuals and families that have donated so much for the sake of our education. During the Cadever Memorial Service, students recited poetry, performed musical pieces and spoke about their experiences in anatomy. I had the privilege of presenting "Life," a collection of my photographs I dedicated to the donors and their families. I selected images that embody life, everything from photographs of the ocean to photographs of roses and nature.

The idea was to celebrate the lives of the individuals, who have taught us so much. I also read the following essay that I was compelled to write after our last lab, which involved dissecting the face. Reading this essay to my classmates and faculty gave me an opportunity to reflect and receive the closure I have been seeking during every anatomy lab.




Exposed
By Eisha Zaid

Using a scalpel, we made an incision along the midline of the face. We then peeled the flaps of skin from each side. With the skin pulled back, we began the process of removing the soft yellow fat to identify the muscles, nerves, vessels and glands on the face of our cadaver.
***

The experience of anatomy is one of transformation. There was the initial trepidation involved with actually cutting another human body, the inevitable smell (a mix of formaldehyde and rotting tissue that can be unbearable), the crowded table of inquisitive first year medical students asking questions, negotiating scalpel time and spending countless hours navigating the body looking for structures.

And there were all the moments of realization that we were becoming doctors.

***
I never knew I would one day be cutting some one's face. Before we began the face dissection, we removed the gauze, strip by strip, to reveal the face of our cadaver, the same face that has remained hidden from our view and from our thoughts through the entire year of anatomy.

It was so odd looking down at her swollen face; she was frowning. As I made the incision on her pasty white skin, I did not even flinch. This is not normal, I thought. Just a year ago, I would not have been able to look at our cadaver’s face. And today, I was actually dissecting a part of the body that is so personal and unique. Seeing her face reminded me that we are working on individuals, who each had very different lives.
***

We all start anatomy with our fresh blue scrubs and wide-eyes ready to visualize the human body from the outside to the inside. We learn fast to detach the human identity from the body that looks up at us from the metal table. We quickly dissect and cut away, looking to uncover the particular artery or nerve or muscle, dirtying our scrubs and getting our gloved hands covered in body juices during the process.
We initially struggled to make sense of the complex language of anatomy. And with time, continued exposure to our bodies and repetition, we memorize terms and locations of key structures- sometimes at the expense of looking at our cadaver as a vessel of parts.

***
When I looked down at the opened face, I began to wonder about her life. Seeing her face evoked some deep questions. What was her name? Where was she from? What made her smile?

And then I thought about myself and how far I had come from the first year medical student that grimaced every time we opened our white body bag to the one holding the scalpel.

We easily forget the human story of the individual, when we have three hours to plow through a list of objectives and bold-terms. And yet, in the back of mind I cannot help but feel guilty.

I still wonder about her story and her life. I know all about the intricate structures of her anatomy; I have cut her face, touched her heart, removed her lungs, felt her uterus, cut thin slices of her brain. It is remarkable what she has taught us and yet it is so sad to have done so damage to her body. I know nothing about her as an individual, aside from the cause of death (renal failure) and gender (female).
***

We all have those moments of human realization, when we are startled by what is in front of us. Seeing the hands, face and toes remind us about the truth that we sometimes suppress. We realize that we are opening up the bodies of other human beings, individuals who were once mothers, fathers, sisters, brothers, friends, and members of the same society we live in. But we learn to not be bothered and continue to expose the body.
***

I will never forget our cadaver’s face; she has watched over us all these months and has seen how we have changed and now we have seen her. I still wonder about how I could I so easily take a scalpel and destroy her face?
***

Anatomy has given me more than just knowledge of the structures of the body; I walk away with a deeper appreciation for the fragility of life.

I am deeply indebted to the family that donated the ultimate gift for the sake of our learning; I cannot even begin to express my gratitude for what I have been bestowed from complete strangers.

In the end, anatomy has taught me to always remember the human within ourselves, especially when it stares right back at you down from the dissecting table. As we move forward in our medical education, we must remain empathetic and compassionate to our patients, asking ourselves how we would want our bodies treated when we are exposed.

We cannot completely detach the human spirit from the bodies that have taught us so much. And we cannot disconnect ourselves completely from the human within us.
***

Getting Closer to the Kidney

I scrubbed in my first surgical case yesterday. Before I scrubbed in, I placed the Foley in the patient. I first cleaned the vaginal area and then advanced the yellow rubber tube through the urethra, what looks like a dark whole.

When I walked into the OR, my arms were up in front of my face, dripping. I realized I was about to get the closest to the surgical field I had ever been. Once I donned the blue gown and plunged my hands in the gloves, I made my way to the operating table, gaining a whole new vantage point, so much different than looking from the corner or over the shoulder of others. I was actually part of the field, my gloved hands rested on the patients abdomen as we began the partial nephrectomy, a procedure that involves removing a portion of the kidney. In this case, the procedure was indicated to remove a suspicious mass.

An incision around the lower ribs was made and we moved through layers of fat and muscles until we got deeper to the fatty pouch containing the kidney. During the process, I helped retract (hold tissue back) and suction. Once fat was removed and the essential vessels (the ureter, renal artery and veni)were identified, we were rewarded with the a view of the left kidney.

The pink kidney was glistening and we could make out the mass on the lower border. Before cutting the mass, the arteries were pinched off to prevent bleeding. In such an ischemic state, "time is kidney," so we need to work quickly to prevent irreversible renal damage.

The mass was cut out and the kidney was eventually sewed back together. Layer by layer, the tissue was sewed up. Assisting at the table was quite an experience and has given me a whole new perspective. We'll see what other organs I will get to see even closer.

Thinking about Thinking

Last time I checked, emotions are a little more complicated than the above poster would lead you to believe. I guess I'm feeling anxious right now; I am in the thick of studying. According to our instructors, stress is actually maladaptive to learning, since the fear response inhibits developing long-term memories, a process known as Long-term Potentiation in the hippocampus (the memory/learning part of the brain. So, to maximize learning, I am limiting stressing about the test. Hopefully, a strategy I can adhere to.

It's interesting. Studying for Monday's exam has made me think about thinking. Learning about how we think, learn and remember things is so bizarre. As I process the information, I can't help but think- "so that's what is going in when I sit here and passively absorb the words on the syllabus page."

If only there were a way to maximize usage of specialized learning circuits to divert my brain's energy to making sense of all this information, everything from psychiatric disorders to sedative and anti-convulsants drugs to the pathobiology of Ischemic Injury to all the other topics I have yet to explore.

The mind is complex, fascinating and mysterious. And even after spending the last 48 hours focusing my attention on my mind, I am struggling to make sense of all the complexities and subtleties of this amazing creation. Let's hope, I gain insight soon, or at least before 9 AM tomorrow morning.

Cheers to the mind!