Block 2

Clearing on a rainy Wednesday post Block 1 exams

We've begun our second block of medical school, titled "Cardiovascular, Renal, and Respiratory Systems". They say that this is when medical school actually begins, and that the previous block, which was a foundational course in biomedical science, was just an extension of undergrad. During our first lecture today, the prof-doc said that what we learn today will enable us to help patients 10 years down the line. My colleagues and I looked at each other in hopes that we would remember what we would learn today in 10 years time.

Reflections on the first block are many. It's still scary to be this entrenched in something and know that I'm going to be here for many years. I don't know why it is hard for me to commit to life as a physician, but I think it's because I like to hold onto change. Change has been the only constant in my life (and may be the only constant in all lives), but I have been one to particularly embrace change. Thus the idea that I am beginning my life as a physician and that there is no turning back or changing course, is hard for me to fully accept. It may be true, but I think that the best way for me to go about it is to envision the next 7-9 years of my life as the period in which I study medicine and become a physician. I can embrace this- it seems manageable. But to envision my whole life from now on out it is too overwhelming.

So the first block of medical school was great. Challenging, sure, but also very productive and exciting. I could feel myself growing as an individual, learning to think in ways that I hadn't before, making friends that I hope to keep for many years, and getting into a routine of school, exercise, fun, gardening, and random things. There is a balance here that I've been working to find, and my life as it has been is something that I feel can be sustained for a number of years. Don't get me wrong, I was very excited for a four day weekend, but I'm also happy to be back at school.

Study scene in the yurt-boat

Something I hope to change from the first block is my level of focus. I often found myself studying with half my consciousness in another place. Being more deliberate about when I'm studying, and also when I'm not studying, will help me stay more in tune. I also want to stay aware of the larger picture: the weeks of learning and not just the days of each block. I want to remember that most things will eventually come together, and that if I can't immediately understand the larger picture, I eventually will. There is a certain amount of trust involved here. I can only believe that the people designing our curriculum have a plan for how this stuff all relates.

Block 1 party scene: arrival in Santa Monica

So I'm ready for this next block- I feel more comfortable and aware.

This is a long road

I came home from school today not feeling so good. An afternoon conversation with a fourth year medical school student reminded me of how competitive it is to get a residency in California. Even for primary care? Less so, but still not easy.

In days past I had been having dreams of this plan: to continue living in my tent for the next seven years, meaning four of medical school, and three of a family practice residency, and to begin my life as a board certified family practitioner with no student debt.

This tent is amazing, and as I begin to get busier with school and then the 80 hour (or more) weeks of residency, I see no reason to switch over to paying rent in a walled structure that I would rarely use. So as long as my dad and step-mom are ok with having me as a squatter in their backyard, I could stay rent-free and use the little money I earn as a resident to pay back student debt.

But that was assuming I would easily place into residency here in Los Angeles, which after my conversation today, I was reminded that it wouldn't be that easy. So I was feeling a bit disheartened. I also donated blood this afternoon, which may have added to my depression? Who knows.

The blood story is that the blood bank people were set up in the hallway going to the cafeteria, and as I walked by between classes, I asked if I could donate in time before my next class. They gave me a mildy convincing answer of "probably", that turned out to be possible, and I was able to leave some erythrocytes behind before going to learn how to perform an abdominal exam.

Cholera and caffeine are somewhat similar. Right? Both the cholera toxin and caffeine potentiate the cAMP response, ableit in different ways. Caffeine acts as an antagonist to phosphodiesterase, an enzyme that breaks down cAMP, thus increasing the time cAMP remains active in the cell. The cholera toxin, on the other hand, binds the G alpha protein and causes increased activation of adenylate cyclase, the enzyme that produces cAMP.

Now. What are the effects of cholera? Diarrhea. And coffee? The shits.

So cholera and caffeine are somewhat similar.

The life of a student is really great

I've been studying all day. We have our first block exam in a week and I have the next 10 days scheduled by the subject in need of review. Today was cancer and inflammation. Tonight is histology of the skin and connective tissue. Tomorrow, embryology. And during the following days I'll continue my crash course in genetics, cell signaling, immunology, and then the exam.

As may be apparent from the somewhat disparate list of topics to review, this first block has been a sprinkling of the medical sciences. Many students have complained about the lack of cohesion, and I understand where they are coming from. Students are also just really good at complaining, and I guarantee that as the we step into the more ordered blocks, ones that are defined by systems, such as "Cardiovascular, Renal, and Respiratory Medicine", we will continue to complain.

Its really easy to complain. Look, I'll even make a list: it's hard, there is too much material, the professors are't good, why we are learning stuff that we will never use as physicians? At this point in my medical education, however, I have no reason to complain. Not even during this eccentric block.

In fact, I have all the reason to laud what has been labeled "Foundations in Medicine". I love the fact that we skim across details and instead focus on the larger picture. This is how the immune system works, these are the basic patterns of inheritance, and check this out- this is how a baby is made!

So now, as I begin my process of review, I find it more enjoyable to be in constant awe of this beautiful painting I am creating of how the human body works, and often times doesn't work, and feel very grateful for this artistic opportunity.

Basically how I feel is that if this block has been the foundation of medicine, I can't wait for the next phase of building.

Is this for real?

I sent this to my brother saying:

TAKE THREE MINUTES TO SEE WHAT I'M LEARNING IN MEDICAL SCHOOL.

IT IS SOOOO INTERESTING

He wrote back saying:

Max, the C3Ab2A anaflotoxin protease inhibitor compliment complex was so fucking cool. I couldn't believe the cylindrical antigen aggregated antibody activation by cross protealyzis on the labile pholyester!! My peptide fragments are totally fucking fragmented. Whoaa.

I responded:

Ben,

Yes. I think that you are suffering from an autosomal recessive disease called phagocytoseme where the alleles responsible for producing protein C1 have a missense mutation causing constitutive activation of the C3 convertase and you have been accumulating C3-dirty-b all over your cell membranes since you were born. This explains your constant desire to clean yourself, because C3-dirty-b also activates the cleanme region of the superior portion of the anterior inferior large cortex. Clinical trials have shown that the only treatment for this disease has been consistent mud baths until the patient acquires an adaptive immune response to being dirty.

I'll treat you in October when you come to LA.

Tonight,

on this Sunday before the seventh week of medical school,

I feel like a man preparing for a long journey.

With chart in hand, I've mentally navigated the days and hours that await me:

Alphabet named cells and self-destruction are on the horizon,

scenes of disease and healing will emerge,

rivers of immunity will be waded through

and by the end of the week,

I will arrive at a greater understanding of the human body's adaptive armament.

In deep

Embryology II: Germination

I'm in deep. Medical school is for real, and I love it. Friends and family keep asking me how I'm doing, and my singular response has been that I'm doing, meaning that I'm always doing something. School is keeping me busy with a direct focus- learn. More than "learn", however, I'm trying to keep the focus on living well, and not on doing school.

To me, the difference between doing school and living well is the following: doing school infers a clear (and awaited) end. If you tried to translate this mentality to living well, it would sound, well, crazy. Right? You wouldn't wan't to be doing life so as to arrive at a clear (and awaited) end. This happens naturally, such is the nature of life and death, but the continuum between these two points is what I'm choosing to focus on.

This is where the independent learning happens: studying in the yurt

Confused? I'll clarify. I feel as through I've begun my career as a physician already, and while medical school is tough and I'm kept very busy, I'm choosing not to get stressed, because I don't want to live a life full of stress. I don't want to live a life where I'm consistently waiting for the real good times to begin. And with medical school, I don't want to feel as if it were just another struggle to survive before beginning my career, where life will be good. I have begun my career of constant and applied learning, and as I said earlier, it feels great.

A nice photo from a wedding in Seattle. That's Kelly and Willy, Bowdoin College friends, and more importantly, Potter Street Pirates

Digging in

Does planting seeds count as studying embryology?

I started school two weeks ago-actually three, but the first was a week of orientation. So two weeks of classes and we've covered genetics and gene expression, embryology, and a few other things. I wanted to get this blog started before school began, but obviously didn't. I've been figuring things out over these past few weeks, getting a sense of what medical school is all about, what is expected of me, when, where and why. This has been a dramatic change from my life over these past two years, the first of which was spent abroad on a Watson Fellowship working on community bridging projects in Peru, Spain and Morocco (check out my blog from that year at swimaroundtheworld.blogspot.com). This past year I was in medical school admissions purgatory, which wasn't all that bad considering I spent part of the year studying agriculture in Spain, and then after falling into a cosmic pond in Mexico the universe finally brought me and my longtime love Clara together.

It has been a very liberal two years of self made goals, responsibilities and schedules, and now the transition into medical school has occurred without me having a firm grasp on what I was transitioning into. I had a lot of ideas about what medical school was, and like many things in life, I didn't really know what I was getting myself into until I actually began. Two weeks in I can't say that I'm an expert, but at least I'm feeling really really good about this whole experience.

White Coat Ceremony

My favorite tool is a pick-