Weeks 39-40: Research Selective

I spent the greater part of this selective learning about clinical research as I've started a project studying atrial arrhythmia's in patients undergoing hip surgery. We've met with statisticians and our work is in progress and I will report more on this as it is presented and published.

Weeks 33-38: Microbiology & Pharmacology

In a whirlwind of six weeks we discovered the most pertinent medical microbes from bacteria, viruses, fungi, and parasites that can drop you dead in hours or bloat you up for years full of worms (as pictured, Ascaris lumbricoides removed from the small intestine)

I've always been a fan of "dark biology" and read The Hot Zone when I was only 12 years old and fell enchanted by Ebola and its deadly 90% mortality rate and by its secret stateside escape in Washington within my lifetime! The sensationalism of The X-Files that introduced me to Hanta virus and it just got more interesting from there. One of my favorite books is still The Demon in the Freezer which puts into perspective the danger of not only dark biology in medicine, but also in the context of biowarfare.

To top it all off, I will admit that Outbreak is also one of my favorite movies. All this hollywood sensationalism sure didn't sway me from electrical engineering though, but let's see if it makes a redux in my career choices in the near future.

Microbiology to me was a realization that this sensationalism was not so sensational at all and as we progressively learned the greater part of the infectious disease medical spectrum I became deeply enthralled by the intricacies of each organism and how they subtly invade the body and counter attack our defense mechanisms, and even our drugs that we throw at it. Now granted that I did a stint in a microbiology lab during undergraduate years, I don't think I truly appreciated the nature of just how cool these microbes are!

I mean take for example our friend bacillus cereus, who doesn't do much than give you an upset stomach but is frequently associated with reheated fried rice? I mean how cool is that to be asking a patient about obscure details such as what they ordered for take out the night before? This is borderline crazy - but crazy in a really cool way that might cater to my attention and fascination to detail.

Needless to say there's a lot to remember and a lot to relearn, but I really enjoyed microbiology and thought that it was fascinating, and for now it seems to be bubbling up my list.

Weeks 31-32: Surgery Sective - Fresh Frozen Virtual Living Pigs?

I guess I really need to be less meticulous when it come to life, take blog writing as an example. The current date is September 30, 2008 and this article is pre-dated back to April, that's a good 5 months behind, but I guess this call-it-what-you-may "attentions for detail" helps me out in at least considering surgery as an option.

We spent a week this selective learning and practicing some basic skills on tissue, on simulation, and then I real live pigs! It was pretty interesting as we learned some of the ins and outs of suturing, knot-tying, making incisions as we worked on day one on some fresh frozen tissues next to some ENT residents who were also working on their skills on dismembered heads. Despite being acclimated to this type of environment I still find it very surreal and disturbing that yes indeed there is much 'practice' in medicine, and sometimes in the most morbid of circumstances to say the least. I mean no disrespect in saying so though as I am extremely grateful for the donors who are willing to help in medical education -- it just seems so primative though for how far along we've come, I would've thought that an entire anatomy dissection would have been in full 3D high definition tacticle reproduction right now - I guess I'm realizing that I just don't have the greatest stomach for gross (in all of meanings) anatomy and perhaps that I'm lowering pathology and radiology from my list of possible career choices.

Strangely enough I find surgery fascinating though and I guess the 'gross' factor dissipates a little more in 'real life.' I shadowed an orthopod doing hand and shoulder surgery this week and saw a rotator cuff repair as well as a procedure that removed some bones in the hand. We also had a session in Mayo's Sim Center where we did virtual colonoscopies, endoscopies, knot tying and sutures with instruments, and even a gallbladder removal that we ended up performing on a living though anesthetized pig! The good news? We got the gallbladder out without the pig crashing. The bad news? Wilbur's prognosis despite the fact was still terminal as they don't wake him up from that sleep again. I guess you can think of it as a better cause than $14.99 in your butcher's case though. Poor pig.

Well that was a taste of surgery for me, another step into a confusing realm of seemingly endless prospects to my intial urge to "want to help people." Now I just need to figure out how.

Weeks 26-30: Pathology, Immunology, Allergy

Pathology wound up to be a quick overview of all the pathology that we won't be really covering in organ systems in second year and focused mainly on inflammation, cancer, and some of the hallmark signs and symptoms of histology that all seems more like a blur. Our teacher, Dr. Grande, also our dean in the medical school did a great job accommodating our needs and taught the block exceptionally well with the help of some upper class men that helped us review and study from resources such as typed lectures, video recorded lectures, and even review podcasts to listen to. It was resource overload, but I appreciated the abundance of resources as opposed to a dearth thereof.

Immunology on the had was a little bit fresh in its organization. Three teacher taught the new course for the first time and they did a great job despite some quirks in the integration of all the materials. The medical school provided us with a textbook that ended up much too elementary and the board review books ended up to be my main text for the class although I wish I had read an immunology textbook proper for the block as it would have solidified my understanding a little better. Immunology was interesting in the sense that there is still so much unknown about the human immune system and in another sense so fascinating that our bodies have such intricate defense systems against the tiniest of organisms - some of which as I found in later in microbiology will drop you dead.

Allergy really was an extension of immunology with IgE and histamine release as the central focus. Interesting how allergy spins off clinically as such a vital differentiation from immunology, but the basic concepts were the same. Clinically I think a lot more people will see allergy as something they have experienced first hand as opposed to immunology that for the most part is passive and less acute than say the rash you got after eating the crab you just got (true story of my 9 year old crabbing experience... I think it was less the crab and more the industrial waste absorbed in the crab that I was allergic to).

The block ended in a most eventful way with a catastrophic internet failure Mayo network wide the day of our NBME (online) shelf exam final. So far our class has had the worst luck with test administration ranging from computer failures, mac incompatibilities, to now this. Who could complain with Dr. Grande though who waived the final and gave us the chance to take it electively after our selective? This was the most refreshing and low stress didactic block by far.

A Tale of Three Wii's

Finishing another block pushes me another six weeks behind on the blog, but it suffices me to say that all's well that ends well, and so it was with microbiology and pharmacology. Actually microbiology was really interesting and hopefully on my week by week recap I'll be able to highlight some of my favorite microbes for your entertainment.

Pharmacology on the other hand was not one of the most organized classes we've had here (thankfully microbiology was one of the best), so sometimes lectures went long and tangential. One day in the middle of the block I was slouched over, daydreaming, and more or less catatonic when all of a sudden in a cacophony of forgotten-to-be-muted rings and chimes I was startled back into reality as my phone started ringing, notifying me of a new text message, a new voicemail, an email, and an instant message--it was a wiialert! I didn't have a moment's time to lose as I knew that I had to act fast. Faster than an orderly running for a crash cart on a coding patient I was at Amazon.com within seconds checking out with 3 Nintendo Wii's for a pricey $750. They sold out again within a minute's notice but my order which I had attempted many times prior had finally gone through.

So the story ensues with 42 of my classmates + 1 world renown lecturer looking in my direction as I pursued the three elusive Wii's. I had postings up on Craigslist and the Mayo Classifieds within minutes, and within minutes I had two calls from people who were already interested in buying them. There was just one problem: I didn't have any of them in hand yet. One of the callers however decided to stick with me and he became Wii #1 starting my story of the three Wii's.

Wii #1 went to a man who's wife went in for surgery at Mayo and needed something to keep her entertained while she would be recovering for the next few weeks. He showed up in leathers looking like he was ready to kill, I thought he might be with Hell's Angels as he unrolled a wad of cash and gave me a cool $300. I was waiting for the ATF and FBI to jump me at any moment and I think I still am.

Wii #2 "Hi this is so and so from Luther Midelfort Northland am I speaking to Dan?" is what I heard when I picked up the phone. Confused and swearing that I heard that so and so was from Dunder Mifflen I was bracing to retaliate against this unsolicited sales call on my donotcall.gov phone number. I was pleasantly surprised however when the individual on the line inquired about the Nintendo Wii and I was even more impressed that they turned out to be a Mayo department. "Umm sure I can take a corporate check, and send it through the Mayo intraclinic courier system... or I could drop it off to you..., wait, you're in North Wisconsin!?" Wii #2 is pending a Mayo Clinic billing department corporate check. I sold a Nintendo Wii to the Mayo Clinic!

Wii #3 Went out the door this morning. I had just come in from playing with Mikey outside in the 1/16th of a inch of snow we received last night when I got a call from a desperate women on the other end of the line. "Are you Dan? Do you still have your Wii available?" I told her I did and was immediately barraged with "Thank you thank you thank you thank you - you are my hero - thank you! Can I buy it from you right now and can we meet half way?" Considering the notion that I would need to get ready and go somewhere I was caught off gaurd on this lazy Saturday morning and mustered up little better than a prolonged "Ummmm..." "Well you see, my best friend is having a wedding and it is right now, and I'm the bridesmaid, and I didn't know these damn Wii's were so damn hard to find in the whole city (try the whole country I thought to myself), and now I'm late and I need one to give to them because that's what they wanted and I've been looking all morning." *Sigh* fine, I can get ready I thought to myself, heck I can even dig up a gift bag for it, but what frightened me was what she asked next: "So how much does a Wii usually cost? Is there anything wrong with the one that you are selling? Can you promise me that it will work?" This is an example of a very bad buying situation for the buyer, had I been a malicious salesperson I could've probably exploited this situation pretty badly and left the buyer out of money and out of luck. But being the nice guy that I think I am I only scooped her for the $50 commission and now in turn have christened a wedding with a Wii.

So there really wasn't much of a point to this post. Sure pharmacology was probably the worst of times, and this wii alert in class that day probably was the best of times, but the real enjoyment that I had from the sale of these three Wii's wasn't the fact that I could pay our utilities for three more weeks, but rather the three little crazy vignettes that I otherwise never would have acquired. So the moral of the story is: if you ever stumble upon a stash of Wii's one day, maybe try picking one up and if not to play, list it for sale and see what comes your way.