Week 9: Finishing Block II

Didn't touch the TV this week, didn't even spend much time to eat, slept five hours a day, and the rest of it was reading. From Saturday morning all the way through Friday at 8:00 am was spent intently learning - oh basically how to identify any histological specimen in the human body. The thing is that up to Saturday we only looked at the four types of tissues: epithelium, muscle, nerve, and connective tissue, but suddenly by this week we also needed to know 11 more organ systems. The result? I decided to read yet another 400 page atlas of histology (this is in addition to the 400/1200 page histology text that was too dense for me to finish, and also our genetics textbook), and did so over Saturday and Sunday. Throughout the week during Disruptions we found some cool quizzes at Blue Histology (check it out and try for yourself - what can't you tell that the inset picture above is the adrenal cortex with left to right showing the capsule, the zona glomerulosa, zona fasiculata, zona reticularis, and the medulla? Oh didn't you know that the three zone respectively produce mineralocoricoids such as aldosterone, glucocorticoids such as cortisol, and sex hormones such as estrogen, testosterone, and DHEA? Yeah, that pink bubble gum colored image should have told you that), that we did ad nauseum to try to get the hang of identifying organs. On Tuesday was my group's presentation of the Endocrine system on our intranet, and by Thursday all our presentations were done and we had become "masters" of system-wide tissue identifications -- right.

Regardless Friday at 8:00am came around too quickly and the brain dump began: 1.5 hours of NBME shelf exam questions, 0.5 hours of genetic online research, 1.0 hour of histology recognition, 1.5 hours of genetics free response. By 1pm it was over and hopefully we have all passed. I was spent, but at least Block II is now over! A two week break buffers the start of Block III

Week 8: Don't Shake Your Baby!

Disrupted by Disruptions in Development this week still, I decided to make the most out of it since everyone (except the four that decided now is a good time to start skipping class) was in the same boat with me. Let me tell you, class from 8am - 6pm wears you down very quickly. If it were not for the promise of a two week block selective coming up I don't know how I would survive it. That's one thing about Mayo's curriculum that I really enjoy - it's a lot in six weeks, but at least in six weeks it'll be over and you'll have a break for two weeks. I don't know how I could do 12 classes for a year vs. two classes in six week blocks, six times a year.

Aside from frantically whipping together a team presentation of the endocrine system for histology, we had our standard fare of genetics and histology. Something of note from our studies this week came from disruptions in development in our discussion of a case of shaken baby syndrome. The moral of the story is to not shake your children even for a minute! It makes me paranoid as to whom I leave Mikey with. Here's what happened to the kid over his development. Names, dates, and location have been fictionalized.

May 1982: Nowhere, New Hampshire
Massachusetts General Hospital PICU
George is brought in by paramedics thinking he has meningitis/meningococcemia. He has bruises on his extremities in the shape of fingerprints on the child's arms. He also has retinal hemorrhages and a broken femur. George has the markings of shaken baby syndrome - bruises over bony parts is not indicative of abuse.

July 1982 - George can't see, won't eat, and has seizures. Katie, George's mother who didn't do it is nevertheless charged with neglect - "poor judgment of boyfriend," Katie's mother (George's grandmother Lucy had temporary custody of George). Peter (Katie's boyfriend) is convicted as he admits that he "shook George for 1 minute." George is on phenobarbital through a year.

December 1982 (14 months) - Peter is indicted and a warrant is out for his arrest. George has a hard time seeing, his eyes are bothering him. He sits up at 11 months (normal 6 months)

At 16 months 1983 - Peter is arrested, but out on bail - working as a security guard
At 17 months (Easter) George on top of table - taking some spills
At 21 months - Peter is now saying John, his gay roommate did it; George has delayed speech, physical therapy, therapists, eyes drifting, can't see well out of both eyes - eye floats out and can't focus
At 2 years - George's neck still on shoulders, left side obvious still has problems, attached to mother
At 2 years, 4 months - 1990 - Peter is found guilty, waiting for sentencing, DA had 22 witnesses, trial of 3 days. Operation on eyes George, falls all the time. George's left side is disabled. Peter is sentenced 1.5-5 years state sentence. Peter offered money to Greg, parole officer, judge recommended prison - no remorse. Katie gets married to an older man and George loses state help. George goes to school with speech therapist
At 6 years old - caught up, but has trouble holding pencils, left side not better - hard time dragging leg and has trouble breathing
At 7 years old - civil suit filed - "shaken baby victim gets 1.55 million," George has IQ 76 - many learning disabilities
At 8 years old - bratty
At 9 years old - Visits Shriner's hospital, goes to special classes. George has a hard time grasping words but can't read. Does well with math
At 10 years old - still in special education
At 11 years old - 5th grade, can't read, can't write - rides bike
At 12 years old - much difficulty in school, 6th grade - don't know what they are doing, can't read
At 16 - Greg doesn't have many friends
At 18 - Greg made cake, made plans for birthday party - no one showed up

So seeing that this boy's mother's boyfriend shook him for 1 minute and basically destroyed this kid's life - if you would like to baby sit Mikey, be sure to bring your criminal background check with you.

Week 7: Disrupted Development

We've met four days in a row now for a new class called Disruptions in Development - potentially my own development in this second block, but so far surprisingly it has been a very interesting class. The first time that we me we were introduced to a 30 year old man with cerebral palsy who had a deep brain stimulator, and then a lady with issues with the medical system. Without too much introduction I quickly realized that this is a psychology crash course with live, real patient stories that have been very interesting despite four hour class blocks.

We have so far discussed developmental lines, genderizing brain, lethal genes in families, and attachment. Some of our guest patients that have been interviewed before our class have been a patient with gender identity issues, a patient who found out later in life that she was actually genetically a male, a patient with Huntington's disease, a patient oncologist whose family has all died of cancer and who has had prophylactic surgery to remain alive, and a severely neglected, abused, and traumatized nine-year old who is in the midst of family issues including drug use, murder, hallucination, and attachment problems. Due to the sensitive nature of their respective cases I'm not too privy to disclose many details, but needless to say they have been effective visualizations of psychology in real life. To the credit of the course, and to psychology in general (which I thought I really would not like), it's so far turning out to be much more interesting than I expected.

On a lighter note, here's a anecdote that's supposed to be a funny Friday moment:

Advice: Always let the patient respond to bad news

A doctor sees a patient who exclaims: "Doctor the two greatest fears I have are cancer and Alzheimer's" The doctor looks at the test results and tells the patient "I'm sorry the test results show that you have cancer." Being an astute student of psychology he allows the patient to respond to the bad news as he distresses about how terrible the news is. After a short while he continues "… and unfortunately we've found out that you also have Alzheimer's" The patient perked up and exclaimed excitedly: "At least I don't have cancer!"

Trust me, it's funny, and if you need some help Wiki: Alzheimer's

Off to spend another weekend as I spent Labor Day and last weekend: studying. On a lighter note our class put together a video for a school celebration that we had Tuesday night.

Week 6: Medschool Impossible

For any of you that questioned how a medical student has time to go to the zoo? The answer is that they really don't. I've rather been extremely busy reading and writing, writing what? Obviously not the blog as these recent posts have come belatedly, but rather this: a 450 page masterpiece that spans three weeks worth of work at Mayo Medical School in genetics and histology - and these are only my notes. At this rate I'll graduate with 30,000 pages of notes! Just think of the forests that I would kill just printing this up. Good thing that I've adopted a 100% digital system that I would highly recommend to my current and future medical buddies out there: Microsoft OneNote 2007.

We had some unique breakout sessions in genetics this week which was out of the ordinary by visiting some of the resources available here at Mayo, including touring its cytogenetics lab, it molecular diagnosis lab, and another genetics lab which I've clearly forgotten the name of. It's worth mentioning that the first week of school we also had a tour of the microscopy labs here including transmission and scanning electron microscopy. The highlight of the week however was spending the afternoon observing my mentor again - an orthopedic surgeon. I observed him in clinic this week as he visited pre-op or post-op with patients. In treading the path of becoming a doctor I asked him inquiring what directions he used when he was walking in my same shoes. Medicine or Surgery is the short answer that I need to know in two to three years. For now: Physical Examination of the Spine and Extremities should keep me busy as I self train to examine his patients in the future. Fitting in time for this extracurricular study is going to be challenging in light of recent developments:

So ever since we've acquired expanded cable, I've fallen in love with Wednesday night's Food Network show: Dinner Impossible in which the chef is put in increasingly more difficult situations to try to successfully cook and feed VIP guests. Someone pulled a quick one of three quarters of the class including myself as some cryptic class came into our schedule radar for the next three weeks from 2-6 pm called "Disruptions in Development." Just to illustrate - this class runs through the day before the final in genetics and histology which by themselves have already absorbed 98% of my waking hours. So starting with Week 7-9 we now have class consistently from 8am-6pm with the only break being 12-2 pm for lunch which we spend 1-2 pm reviewing histology. How fun. I feel that I've become my Wednesday night idol and am myself placed in my own reality show: Medschool Impossible.

To the credit of Mayo though it is pass/fail and I only need a 70% to pass… but when was it even a remote consideration of mine to not pass a class, and especially not get a 70% or more? Oh, I wait... I think that time would be no. Welcome to medical school, we've kicked it up a notch.

Week 5: Cougars, Badgers, and Bears?

The second week of the didactic core was rather uneventful - oh wait, except for the two hundred or so pages I had to read and digest for this week spanning such topics as multifactorial inheritance, epithelial tissue, cell division and chromosomes, population genetics, connective tissue, cartilage and bone? - I guess that's uneventful. More of that in the next entry since I'm writing in retrospect and there's even more to add to that list following week 6.

Week 5 finished up our introduction to the patient experience for a little while as the course only meets intermittently through April 2008. My second patient experience this time had no camels involved, but was rather a portrayal of an old woman with her grand daughter who felt faint and dizzy after riding the roller coaster at the state fair. There was not anything too spectacular with the patient's medical history, or rather me taking that history so I guess I could call that progress from last week.

I took Friday afternoon off after we got out rather early which was something that we enjoyed this week (getting out Tuesday, Thursday, Friday). Carolyn decided it was time to visit the zoo closest to us in Oxbow Park. Seeing that I had nothing better to do than to study on a beautiful Friday afternoon, we decided to go and Mikey loved it: sorta.

The zoo is fifteen minutes outside of town is situated in a state park (Oxbow), situated around corn fields and soybean. What started as a collection of injured animals now is a semi-grassy oasis in the middle of nowhere with caged animals such as otters, badgers, owls, a pair of bald eagles, a cougar, a wolf, a black bear, and even a petting zoo of cows, goats, and chickens. It just seemed to be an anomaly to be in the vast surroundings of agricultural Minnesota and suddenly see a wolf running laps in its cage, or see a cougar eating a big chunk of steak on a fake tree limb. Welcome to Rochester I guess. Mikey loved the waterfall in the bear cage - no the lumbering multi-hundred pound flesheating beast didn’t deter him - he wanted to play in the water. I think we have a ways to go with Mikey still.

Week 5 segues into week 6 which ultimately was the relative calm before a before a secretly brewing storm.