Merry Christmas & Happy Holidays

Merry Christmas and Happy Holidays!

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Dear friends and family, a cold and snowy greeting we’re sending your way from Rochester, Minnesota—a place we now call home. We moved here this past July and purchased a nice little townhouse close to the Mayo Clinic where Dan is now attending medical school.

Dan is busy studying through his first year of medical school and has finished his first blocks which included histology, genetics and genomics, gross anatomy, radiology, and embryology. Dan’s chronicles of his medical school career have begun on his blog viewable (here of course!) Needless to say, he’s glad he made the choice to come to Mayo and loves the opportunity studying here.

Carolyn is also very busy as a full-time mom and also as a part time dance instructor as well as a teacher at a local daycare. She’s also starting up private piano lessons beginning in January. She enjoys digital scrapbooking and takes care of our little bundle of joy: Mikey. Her adventures of our family are written at http://danandcarolyn.blogspot.com

Mikey is now 18 months old and he is loving life here. He’s got 12 teeth now, is fully bipedal and navigating stairs standing up, and has a repertoire of words that include: “wadder, bahbul, bawl, mmm, uh-oh, woof-woof” along with “ma-ma” and “deeyeh.” Mikey currently writes no blog, but he is going to go bonkers over his wooden train table, Tonka truck, radio flyer tricycle, musical bongo drums kit, and the other thousand items under the tree that he will discover tomorrow morning.

With that we bid you a Merry Christmas and Happy Holidays with all our love,

The Chan Family
Christmas 2007

Week 20: Sexual Medicine!

Now here's a topic you don't get exposed to typically in medical school so much as life in general as well. The irony here is that we have 35 hours of lecture in this one week of sexual medicine than we had for the entire six weeks of gross anatomy! I guess we're kind of delinquent in this subject that is too socially taboo to discuss.

Well the taboo nature of it is gone as we learned the ins and outs of sexual health from intimacy, healthcare, stigma, culture, slang, gender issues, sexuality, disorders, offenders, and even law in the week long first week of our block four leadership block. It was actually quite interesting as not only did we have lecturers, but more impressively panels of guests. Included in these panels was a teen panel from Planned Parenthood discussing how nearly 50% of their peers were sexually active, also a couple with sexual dysfunction and their story of it (we also received their book), a panel of a sexual assault crisis team including a rape nurse, victim advocate, prosecutor, probation officer, and police sergeant. On the flip side we also had two sex offenders come in to talk to us which really chapped my hide as these guys got off easy with only 12 months in prison. 90% of sex offenders go unreported as these guys attested of that as they admitted they were chronic offenders for decades and only got busted for their last offense a few years ago. So according to the wonderful Minnesotan legal system here they only got 12 months in prison and are now on probation. What kind of messed up system do we live in here!!? I mean to contrast, if I as a physician have a romantic relationship with a patient I face 10-15 years in prison and a $20,000-$30,000 fine and loss of licensure, whereas if I go molest little boys I get off with virtually a slap on the wrist!! I'm buying a shotgun for Christmas and Mikey's never going to have a male babysitter (as 90% of sex offenders are male too).

We had a bunch of interesting lectures on geriatric sexual health (how elderly never stop having sex), transgenderism and GLBT (very interesting panel! (the man who was born a woman had me totally deceived), and interesting hands on workshops on contraceptive usage and solutions to sexual dysfunction (sex toys). Well I'm glad those 35 hours are over, but admittedly I learned about sexual health a lot more in this one week than I ever did in my cumulative education… I mean 10th grade health was taught by Coach Barnes!? - I wonder why we didn't learn very much...

Week 19: A Surgeon's Bane

The surgery work week continued Monday back in clinic from 7am-5:30pm, surgery Tuesday from 7am-5:30pm, and Wednesday and Thursday followed suit in clinic and surgery respectively. Each of the surgery days I left before the last case of the day was even over as the chief resident Dr. Shridarani stayed often to 10-11pm each night and was back at it 6:00 am the next morning. Don't get me wrong, I found from the experiences I had watching multiple surgeries scrubbed in and patient side holding retractors, pretending to review my anatomy in situ, very rewarding and very interesting, but after this week a new realization of the surgeon's lifestyle really hit me. A surgeon's schedule stinks!

Not only was I physically and mentally drained at the end of every day, but with 4-6 hour spine surgeries under hot lights, sweating, and standing on one foot watching the time go by one surgery at a time is unrelenting as well. I mean you could pay me $700 and hour, but at the end of the day, and the end of the week, and the end of my life I probably wouldn't even have the time or energy to spend it all! It is amazing what Dr. Huddleston does in the time he has each day - and that he manages to be so involved in everything on top of it all, from being the president of the bone bank, sitting on various Mayo committees including education, and also being a lieutenant colonel in the U.S. Army as well.

Friday I took off just to recover as our leadership block started up on Monday. At the end of this selective I really reflected a bit on the fact that despite surgery being very interesting, it is also a lifestyle hardship making me question whether radiology or anesthesiology might fare better to allowing me to actually see Mikey grow up which I missed this week.

For now my doors are still open - but in my two weeks to attempt self-discovery in orthopedics I think I found myself with more questions than I have answers for in choosing a specialty.

Week 18: Thanksgiving Touring Orthopedics

For my selective this time I went back with my mentor Dr. Huddleston in orthopedics and followed him. Being the week of Thanksgiving I took Thursday and Friday off to be with Carolyn and Michael as we hosted dinner this year with some friends. Carolyn has the details in the family blog.

On Monday I started off observing Dr. Huddleston's chief resident working in the cadaver lab as he exposed iliac crest for bone graft harvesting. Tuesday started off early at 6:30 am for spine conference in which I learned about how MRI's were not great diagnostic indicators of a patient's recovery. By 8:00 am I was in the operating room as I scrubbed into surgery and got a first hand view of three surgeries, the first being a Anterior Lumbar Interbody Fusion (ALIF) L5-S1 in which I even got to hold retractors. In the second procedure I watched an irrigation and debridement of a case in which the person had developed staff infection following back surgery so they needed to clean out his wound. Finally to end the day, I watched another decompression and even got to suture a bit at the end of surgery closing up the incision. Wednesday I spent the entire day in clinic as we met with pre-op and post-op patients. Dr. Huddleston even had me take a patient history of a lady. Needless to say Thursday and Friday were much welcomed days for rest and relaxation.

Week 17: The End or Just the Beginning?

For the amount of time and effort anatomy has asked of us thus far, it has continued to be unrelenting through to the end. We got barraged with the lower limb Monday, Tuesday, and Wednesday of this week and mind you - that essentially makes up half the body - and were tested immediately on both Thursday with the National Board of Medical Examiners anatomy shelf exam, and then again on Friday with our written test and practical test that spanned another four hours. Without recalling all the traumatic experiences and stress of this week and stirring up my newly acquired post traumatic stress disorder (PTSD), I survived. In hindsight the practical identification of the tagged cadavers came out a like better than we expected. Yes I have survived gross anatomy, but what have I accomplished? 1066 pages of textbook reading in short term memory, check. Virtually nil comprehension of the lower limb, check. Massive apprehension to having to learn any of these systems in greater depth and detail, check. But that was it, after Friday at 12:00 pm my brain decompressed and it's been recovering ever since. The mercy that Mayo's curriculum affords is the two week selective, the three week non-didactic leadership block, followed by another two week selective before our next basic science six weeks starts in January. Anatomy the block is over, but the long term learning is just beginning… well, beginning after I enjoy these seven weeks of neural vacation.

Week 16: The Beginning of the End

Orbit, eye, ear, parotid, temporal and infratemporal regions, pharynx, nose, paranasal sinuses and oral cavity, root of the neck and larynx - piece of cake right? Right… seeing that there was more information in this week alone of lecture than about all the previous four weeks of anatomy combined. Add that to the mounting tension of a looming final next week and it makes for massive stress and little sleep. Sunkist and Mountain Dew became my new found friends.

Mayo teamed up with Singapore to put together a review of the neck using clay models, even if it doesn’t make too much sense it's interesting to look at their art.

Week 15: Halloween Hemisection

Ready for another list? Female and male perineum, pelvis, superficial face and neck, and cranial cavity were the list of objectives for this week as was Halloween though we didn't really celebrate it. In the spirit of creepy Halloween however, one of our dissections was a hemisection which involved dismemberment of the leg and also sawing the pelvis in half (hence the hemisection) so that we can see the cross section of the anatomy through the pubic symphysis. Needless to say a disembodied lower limb was a rather creepy thing to heft around.

Halloween was celebrated by trunk or treating for a bit at church and also a little bit of neighborhood trick or treating for Mikey. As the trend continues there were virtually no trick or treaters on Halloween itself suggesting that the era of door to door trick or treating is over. Enjoy the pictures of Mikey the doggie:

Buy Uranium-238 from Amazon.com!

So, if you haven't caught on yet, I've been trying to catch up on the blogging from a few weeks back, but I stumbled on the oddest product listing on amazon.com tonight I couldn't pass up expressing my "?!" moment, enjoy:

Uranium Ore
Price: $22.95
Availability: In stock. Processing takes an additional 4 to 5 days for orders from this seller. Ships from and sold by Images SI Inc..

Product Description
Radioactive sample of uranium ore. Useful for testing Geiger Counters. License exempt. Uranium ore sample sizes vary. Shipped in labeled metal container as shown. Shipping Information: We are always in compliance with Section 13 from part 40 of the NRC Nuclear Regulatory Commission rules and regulations and Postal Service regulations specified in 49 CFR 173.421 for activity limits of low level radioactive materials. Item will be shipped in accordance with Postal Service activity limits specified in Publication 52. Radioactive minerals are for educational and scientific use only.

We are always in compliance with Section 13 from part 40 of the NRC Nuclear Regulatory Commission rules and regulations and Postal Service regulations specified in 49 CFR 173.421 for activity limits of low level radioactive materials. Item will be shipped in accordance with Postal Service activity limits specified in Publication 52.

But in the words of Levar Burton on Reading Rainbow: Don't take my word for it

Week 14: Video Gaming Good for Surgery?

Abdominal walls, inguinal region, stomach, duodenum, celiac trunk, liver, bile passages, portal circulation, intestines, superior mesenteric artery, inferior mesenteric artery, posterior abdominal wall, and diaphragm - these were the mere topics of this week's learning. If you really want to know the basics of what happened day to day, look at week 13 for a generic breakdown which really encapsulates the feel from a first person medical student perspective.

So how is video gaming good for surgery you ask? Well in an extracurricular activity this Friday, Dr. Dozios from general surgery came to the cadaver lab and demonstrated how to use laparoscopic tools to operate on a fresh (frozen, thawed, but otherwise not preserved thus retaining body fluids) cadaver. Anecdotal evidence suggest that video gamers are more articulate in their hand-eye coordination as well as their spatial perception, both components that are necessary when using laparoscopic tools and doing the surgery via a camera and monitor.

I finally got to cash in on my Super Mario Brothers investment as I picked up the tools and clamped and stapled with ease as I got a feel for laparoscopic surgery. It was a fun first exposure and one I'm glad my video gaming skills have helped develop.

Week 13: A Day in a Block of Gross Anatomy

We finished up the extensors of the upper limb on Monday and spent Tuesday to Thursday learning the whole thoracic area from the regions of the mediastinum, lungs, and heart as we dissected a whole lot of structures this week. Throughout this experience we also had some afternoons spent on our Introduction to the Patient class which teaches us practical skills of patient exam. We listened to lung sounds and also listened for heart sounds although frankly we don't have too much of a grasp on really what we are looking for just yet but only a little bit of how to do it. With time I am confident that we'll be able to master the material a bit more.

This was basically a typical week of anatomy, the ins and outs of a typical day is basically waking up at 5:30 am to preview the day's material, arrive at school at 8:00 am, lecture until 9:15 am, dissect in the cadaver lab until 11:15 am, finish more lecture and get rocked in our Audience Response System (ARS) questions which are basically quiz questions that we answer with our own clickers in 60 seconds each, and done by 12:00 pm. If we have an afternoon class, which run typically 3/5 days of the week we go back to lecture from 1-2 pm and then from 2-4 pm typically we go to a clinical setting to practice either on standardized patients or each other. I get home by 4:30-5:00 pm, eat dinner and unwind until 6:00 pm, and read, study, review and memorize until 1-2 am. The process repeats itself day in day out and you see pretty quickly that you start burning out. The handful of hours between days and between systems that we are learning just doesn't seem to be enough to solidify everything.

Needless to say this week introduced me to the terror of gross anatomy.

Week 12: Friends and Family, Formalin Free!

I got suckered by the 3M Littman Reps and by peer pressure into getting a Cardiology III stethoscope, although we were thoroughly convinced that the limiting factor for the four years of medical school would not be what went in the ears, but rather what was between the ears. Sage advice that I ignored, should've went with the cheaper stethoscope.

Anatomy this week comprised of dissecting and learning the axilla, upper limb including flexors and extensors of the arm and forearm, as well as the hand. We were also introduced to the brachial plexus and all the nervous injuries to the nerves in the upper limbs can produce. It was fascinating looking at our arms exposed - I never would have imagined how many muscles there are that control this region of the body, I guess never appreciating that all our articulation of the upper limb is attributed to various muscle combination that I appreciate in function - now in learning in three days was another story. Our return on investment from an early start to anatomy matured this week as Thursday and Friday were off as it was Friends and Family weekend - more on that in a second. Instead, we had a selective lecture by Dr. Bachman which focused on family practice and an introduction of virtual visits that the doctors have been using here to try to save on visitation costs and to follow up more directly and more efficiently. It was an interesting concept, but I don't think the office visit proper will ever be totally phased away. This does help out though for getting that seasonal allergy prescription visit or a follow up to say that "everything is fine."

Friends and Family weekend is an open house that Mayo Medical School runs for our parents in lieu of a white coat ceremony. As Mayo Medical Students are never given white coats (our clinical interaction with patients is always in suits and business attire), we don't have the traditional presentation of a white coat at the beginning of the year. Instead we are presented with a plaque with a commitment to human values that we take. It felt like graduation, but maybe four years too early - three and a half now I guess. We were also invited to the Foundation House in a nice reception dinner that we enjoyed and it was nice to have my father and mother in law (Paul and Jan) who came up for the occasion and also to visit us. Wish it were four years in the future and we were getting our medical degrees, but alas - just a glimpse of future I hope.

Week 11: Emotions Revealed - Anatomy Begins

I scrubbed in on Monday morning to end my four day weekend a little earlier to observe another spinal surgery. I had a chance this time to watch the L5-S1 fusion from start to finish as the case went about 4 hours from first incision to last suture. They went in anteriorly through the abdomen and exposed the vertebral bodies, scraping the out the herniated vertebral disc, added a bone graft, a titanium plate, and six screws before closing the patient back up. I got a front row seat scrubbed in and got to play around with the mushy vertebral disc when it was taken out. By the end of the week with the start of gross anatomy I would learn that I was mashing up nucleus pulposus and annulus fibrosus of the vertebral disc.

Anatomy started early on Wednesday, skipped Thursday, and continued Friday as we substituted two days out of this selective for Friends and Family weekend over the weekend of October 11-12. With anatomy beginning the fun began as we were introduced to our cadavers on Wednesday and the same day began dissection on the back - with that the fun of learning muscles, nerves, insertions, origins, etc. began [in retrospect: what we thought was nigh impossible to learn in these first two days of anatomy would prove at the end of six weeks leaps and bounds easier than our final week and a half of anatomy trying to learn head and neck and lower limb in seven days]. Being sensitive to the nature of our dissections, the donors privacy and also confidentiality I will not divulge in any details or specifics regarding our cadaver or procedures, but for those of you who are truly interested in what we are doing, you can take a look at the University of Wisconsin anatomy site for anatomical dissection videos that will give you a first person perspective of what we did in the anatomy lab.

We ended the week with a training workshop by the Ekman Group that was paid for by the medical school. The Ekman Group is a team of specialists trained in facial recognition that works with security agencies worldwide and trains personnel in the technique of facial expression recognition and micro expressions. Purported to be more accurate than polygraph, facial expressions are hard to unlearn and retrain - especially micro expressions that only last fractions of a second - but when picked up by experts can be far more revealing that any other means. We looked at footage from the O.J. Simpson trial, various CEO TV interviews before secret corporate corruption was exposed and saw how micro expressions of contempt and disgust were long in existence despite their cheerful faces. It was an interesting seminar and as we trained, it hopefully helped us learn to analyze our patient contact better in hopes of better ascertaining hidden concerns. I thought it was some pretty hi-tech stuff that I sure didn't anticipate learning in medical school to say the least.