Secret Societies and Politics

I have mentioned before that I submitted my letter of intent to run as class vice president (or in Spanish: vice presidente de la clase). Elections start Monday and close on Tuesday. That makes Tues the 22nd the day I find out whether I'm popular enough to get the majority votes. That is really all that anyone has going for them, popularity. We just got here and we haven't even been in school for a month! How should we know who to vote for, let alone if we should run? But I want to run anyway. So fingers crossed.

I also have started into motion something that might really be awesome. I have (hopefully) created the Secret Society of Study Guides. I just sent out an email to the class of 2013, inviting those that would be interested to form a secret society. Yes, we all know about the evils of secret societies, but it won't really be a secret, hence the mass email. But it makes the group sound so much cooler! The goal is to team up with other students who, like me, love making study guides, diagrams, drawings, etc in order to help simplify complex concepts and make it more fun if possible. We will peer review each other's submissions prior to the test and then distribute the separate study guides as a packet of educational gold to the rest of the class. I dream that every student will eagerly wait for the Society's packet to hit their inbox and then they will see several pages of study materials to break up the boring textbook/lecture note studying. It could be... amazing. I am already thinking of t-shirts for those that put in the time and effort into making the study guides and studying early in order to get them out a day or two before the test. It will make me a little more proactive and help fight the temptation to cram, all while having fun seeing what other people come up with to learn the same concepts. I'm really excited and figured I'd share it with my readers.

I finally made it into the thoracic cavity of my patient today in dissection!! My dissection team and I removed the left and right lungs and checked out the heart. I have to say that I never felt like anything was ACTUALLY beautiful in our cadaver's body until I saw the heart. All I could say was, "beautiful." I have seen a bunch of hearts. Pictures of hearts, pigs hearts, even human hearts in cadaver lab in undergrad. But it was the act of removing muscle, facia, and bone that made the uncovering of the heart so breathtaking. Arguably the second most vital organ in the body, absolutely beautiful. Turns out it was humongous, probably due to left ventricular hypertrophy, a comorbidity of obesity. It may have even been the reason for her unexpected heart failure. We won't ever know. Dissection is the greatest thing I do every week.

The worst thing I do every week is not sleep. I feel so tired every day! I need to get more sleep! Which is why I will end this post right now as it is 10:30 PM and I have no tests or quizzes tomorrow, finally!

The End of One Era, The Beginning of Another

It was late last night that I got the news. My grandfather, as so many do, fought in and out of "getting better" and "getting worse" until his body wanted a rest. I was studying for my anatomy test that I took this morning. I tried to memorize spinal nerves through tears. I miss him. He was the last of three grandfathers to whom I had the honor of being a grandson. It was difficult, it is difficult, to be so far away, so busy. But in the challenge lies the reward.

It is clear that medicine will never get a day off. Whether it be a test, a surgery, a patient visit, my life is secondary to the lives of those I serve, those that come to me for help. It was a harsh lesson in the first month of medical school but a clear one. My future patients will deserve nothing less than all of my focus, concentration, and attention, despite the events of my personal life.

I think I did great on the test, although I didn't sleep much. I have a hard time vocalizing my feelings, especially sadness. So I chose to write something instead of trying to talk it out. I want this to be my way of saying goodbye to my three grandpas, who I did not get to say goodbye to.

Craftsmen

For My Grandfathers

I can’t think of a more noble title to bestow on a man;

Craftsman.

Three grand men shared the title; Three grand men shared a grandson.

If there are better lessons to learn from a grandfather;

I don’t know of any but those that my grandpas,

The craftsmen, taught me.

Attention to Detail,

Exactness in execution,

Perspective given to a job to be done,

Passion for a job well done,

Love for family

Love for creation

Faith.

A craftsman lives on in his creations;

Design, Cut, Build, Refine.

We may have not been aware of it,

But they did the same with us.

Design, Cut, Build, Refine.

They live on in us.

My grandpas live on in me.

Our eldest and perfect brother,

Died so that we could live again.

That was his purpose.

His hands bear the marks of his sacrifice.

I’d like to think that the calloused hands of my grandfathers,

Toughened skin from years of hammer, wood, saw, metal,

Would also remain calloused after they live again.

To represent their trade, their calling

Their gifts to us.

How humbled I am to have been given three of these noble men.

Nate left before I could properly get to know him,

But his abilities and essence are a part of me,

A hand to guide my own.

It was Fred that stepped in and took up the mantle.

Nate would be pleased,

Only a craftsman can fill a craftsman’s shoes.

A second hand to guide my own.

And finally, it was Perry;

Who embodied the title of a craftsman from the day he could pick up a hammer.

A third hand to guide my own.

It seems that I am destined to be like them,

but cursed to never be there to say goodbye.

I can find solace in knowing that every cut of the scalpel,

Every stitch I make,

Every stroke of my charcoal,

I have three,

Calloused hands,

To guide mine.

“The first son of my first son,” says Nate.

“Eric, make the lines straight, see the product,” says Fred.

“Hey Tiger, measure twice, cut once,” says Perry.

Thanks Grandpa.

Week 3: Bone Crackin', Test Takin', Tennis Watchin'

Well then, week 3 was a week of historic proportions. Before this week, I had never watched the US Open while studying Biochemistry. I had never used a chisel that you could buy at home depot on a dead person's vertebral column. Most importantly, I had never taken a test in medical school.

I passed my first test! I really did not study for the Biochemistry test as I would have liked to. It seems that the more conceptual something is, the better I can test on it. The more abstract and mathematical the course material is, I have difficulty finding the concepts to make it clear WHY I am doing the math. Biochem walks a fine line for me. It is, in my opinion, very applicable to physiology among other important courses that I will take. So the WHY for me is easy. What challenges me is the rote memorization of amino acyl residues and their chemical structures (all 20 naturally occurring ones) and the somewhat disjointed concepts tied into this first test. With all of that, I decided to try something new. I did what most people would consider "concept mapping". I figure, if there isn't a clear concept, I'll make one up. Turns out, I didn't have to study as much as I thought I did! I will make a recommendation to everyone that is currently in a challenging course for school or in a nursing/law program (Nate, Mike). MAP THE CONCEPTS IN YOUR COURSES BEFORE A TEST OR QUIZ!!! If you go to class, your brain might have been listening while you were chatting on instant messenger with me. Map out concepts of material for the test, making that spiderweb-looking thing with interconnected ideas and you will be surprised how quickly you can isolate the areas that you need to study more and the areas that you know really well. TRIAGE!! It saves a massive amount of study time. I ended up with a less-than-wonderful 85% on my test, but the ice has been broken and a "B" ain't bad!

I had dissection TWICE this week! I absolutely love that time of my week. The only real let down was that we were planning on using the power saw to cut open the vertebral column this week, but upon inspection, the cuts had been made by what were referred to as the "lab gremlins." After I had scoured the lab, looking for the said gremlins while holding a scalpel, I returned to my deceased patient and we were handed chisels. Yeah, chisels. It was a little wild to hammer and chisel at the vertebrae like that but the carpenter in me absolutely loved it! I stepped back and oversaw the procedure after a bit of chiseling, I was the designated leader that day so I quizzed everyone on what we were seeing. Our goal was the spinal cord, which now is my favorite part that we have dissected. It was frightening/awe-inspiring to see the somewhat fragile thing that makes all the difference in our lives. The amount of connective tissue, protective tissue, and white and gray matter that separates a walking, breathing individual from a ventilated quadriplegic is not much more than the thickness of surgical tubing. The nervous system is beautiful. I'm excited for head and neck next quarter!

First anatomy test is on Monday. That brings me to my medical student realization of the week. Medical school is a lot of work. It is not just a lot of material to cover and a lot of difficult concepts that require a lot of time studying. It is a lot of meetings, orientation, activities, surveys, assignments, labs, service, balancing, and...fun. I pause to say "fun" because it is amazing how the "fun" somehow consistently/daily emerges as the phoenix from the ashes. I have joined the medical Spanish club, the surgical club, the intramural tennis league, the intramural softball team, and I just submitted my letter of intent to run for class vice president! I also get to give a talk on gratitude on Sunday in church. So where do Ashley and Bostyn fit it? They are literally and metaphorically the mortar in between the bricks of my schedule. I can't imagine a better break from it all than to come home to kisses from two beautiful girls. But the BALANCE is the real challenge of medical school. Ash and Bostyn are doing great and are being very good about letting me throw myself at school. Ash said she can tell that I am finally where I should be. I can't tell you how awesome it is to be able to give 100% in study, effort, and attention and know that I get back 100% of what will make me a more successful doctor. Not just studying to "pass" or to get an "A" but to study to be a great doctor and to better help my friends, family, and other's friends and families.

Med School is Awesome! GO ROGER FEDERER IN THE FINAL ON MONDAY!!!

Week 2: Welcome to Medical School.

So all of that orientation was a little confusing as they made it sound like they were orientating us to med school. Clearly, I was mistaken. I have officially started the "fire hydrant" phase of school.

I have to warn you (as well as myself) that I will be brutally honest in my blog, no matter how stupid it makes me look. I went through last week, week 1, like school was still warming up and that the real school would start sometime this week. What I am now embarrassed to admit is that I was under the wrong impression.

Background: Undergraduate school was pretty easy. I studied a lot before a test and as long as I went to class a few times, I got an "A". I was pretty good at memorizing things as long as they had some conceptual/visual element to them, i.e. physiology and anatomy. I also was trained to take notes and remember everything when the professor said, "Now, on your test..." I loved those moments because it was like cheating! Only the professors told us so it was only sort-of cheating.

Reality: Medical school is not easy. Take all the "stuff" that you see in your undergrad text book. Try and think back to course lectures when the professor would include an FYI or a brief in depth explanation of something only to further illustrate the testable concept. Try to remember what it was like to have a list of what you DON'T need to study along with the MUST study stuff. Medical School surprised me. It was this week that I realized that the whole time that I was waiting for someone to say, "Now on your test you will need to..." or even a "Everything that we talk about today will be on your test," what had really happened was that they assume that you were told that you have to know EVERYTHING! I'm not kidding.

Take Anatomy for example. I know my anatomy (and yours too!). I have had about four courses in anatomy in undergrad. That adds up to about 14 credit hours of anatomy. That is almost a full load for a semester, just in anatomy! So when we started anatomy last week and all we talked about was embryology and the development of body tissues, I thought we were in the preface! I thought we were just being warmed up for anatomy! I convinced myself that school hadn't started yet due to the ridiculous amount of detail they were throwing at us about something so (in my opinion) unrelated to anatomy that we deal with as physicians. HA HA! Joke was on me, folks! It is absolutely the truth if they wrote on the syllabus in big bold letters: LADIES AND GENTLEMEN, KNOW EVERYTHING OR FAIL. Welcome to medical school.

But despite my assumptions and ignorance to reality, I'm not overwhelmed quite yet. First test is next Friday. We will talk about overwhelmed then. I am, however, elated! My first patient gave me my first lessons today. Here are some lessons that she taught me today:

• Exercise= surgeons can fix you a whole lot easier if something goes wrong.
• Exercise= your body hates you if driving to McDonald's is your exercise.
• No matter what anyone says, beauty is not only skin deep. Beauty is actually attached to the fascia that connects to the skin but it runs all the way to the bone. Dissection was Beautiful!!!
• I am a cutter. No matter what direction medical school takes me, I love to cut, rip, pry, search, and identify. I spent three hours in there and could have stayed longer. Awesome.
• I am also glad that I can make mistakes. It is so hard to find certain things and I end up hacking something that I will have to find later while looking for something else.
• Always have a plan. Even more important than having a plan, have a plan for what you will do WHEN the original plan fails. At least that lesson pertains to dissection. I don't think any of us were expecting having to rip away 15 or so pounds of skin, fat, and fascia in order to START the dissection, let alone how hard it would be to find the tiny veins, arteries, and nerves that we had to identify.
• A dead body has a ton more juices than you would think and they splatter on your fellow dissectors. This does not make them happy.
• I love dissecting. I think I already said that though.

We only dissected the back today, but it was still really cool. I'm getting excited for the internal organs and bones. I'll be back in the lab next Tuesday!

One last thing that I'm really loving. I am so impressed, proud, surprised by the osteopathic elements of my medical education. No where else would I begin to be a clinical doctor my first week of school. I have already role played an office visit! We have a course our first quarter about doctor/patient relationships and how to ask effective questions. I don't even know what the answers mean yet! I love the OMM training. We haven't done the actual manipulation, but the sneaky part of it all is that we are being numbed to the awkwardness of touching a stranger. I have a partner that I didn't know from Adam a few days ago and today he had to lie there while I dug my fingers into his butt cheeks to palpate the ischeal tuberocity of the pelvis. I am not kidding when I say that it doesn't phase me at all. I really don't feel awkward at all. But as I looked around the room at 172 students grabbing each other's butts, I had to laugh. Where else do you go to school and get to do that as an assignment! (no play-on words intended with ass-ignment).

In the end, (there it was again) I loved my second week. I know I have one day left but it only gets better from here!

My First Patient

So day 2 became the most surprising yet. We had our intro to anatomy and dissection today (among a few other classes). I'm feeling pretty confident that I will enjoy anatomy and score well enough to distribute my stress among the other classes that I have this quarter. The anatomy intro was pretty straight forward and was mainly a syllabus breakdown. The Dissection intro was what caught me off guard.

It started as a brief history of human and animal dissection. Human dissection has been a wild ride over the past 500 years (pretty much 1000 years). The history was interesting and I doodled the whole time so I felt like I was back in school again. Then things took a different direction. A professor stood up and gave a lecture on the emotional and spiritual side of human dissection for the purpose of medical training. He had an awesome European accent (possibly German) and he had my attention immediately.

I anticipated the lecture on respecting the bodies of the people that donated themselves for our educational purposes. It is a very necessary and helpful discussion that I have has before while in human anatomy in my undergrad. So I wasn't expecting anything too different. I could not have been more wrong.

He began very straight forward about the privilege of having the cadavers as students and how being respectful of them was so important. He then described how the cadaver is, in a special way, our first patient. We owe the person's body all of the respect, care, and attention that we would want to give all of our future patients. He read a poem written by a medical student that described the emotional and intellectual battle that goes on as a med student learns from the cadaver. How one minute you are making the cold and scientific assessments of the body and its condition, but then consider the person's story. Did she have a family? What was his legacy?

My doodling had stopped completely by then. He had me. He delivered the next part so perfectly that it changed me forever. I was contemplating how great it is to think of the cadaver as your first patient when the professor added something more than just "great". To show us what the cadavers really should mean to us, he read a card that was sent to our school. It was sent by the family of one of the people that had donated their body to the students here. The card was a 3x5 card with short messages from a spouse, children, grandchildren and friends. "Please take good care of my blue-eyed soul mate", "It is our hope that one of your students can find a cure to that cruel disease: cancer", "We love you for the profession that you have chosen", "Please take care of my grandpa".

I couldn't look at the card after he began to read. I tried desperately to return to the safety of my doodling. I could hear tell-tale sniffs all around me. I fought harder than I have in a long time to not get choked up. It was in that moment that the cadaver that I was going to be dissecting over the next six months became a person who was giving me a selfless gift. Every person that I treat will owe the donor of that cadaver for helping me, a brand new student doctor, learn about the amazing human body.

The professor also included a thought from a movie that was made decades ago, starring Carey Grant. He played a doctor who was followed around by the spirit of his cadaver from medical school. While he treated his patients, the spirit would remind him of things he had learned from the body. I pondered that idea.

The students were all sent to the anatomy lab to then meet our cadaver. Four people to a cadaver. We walked across the campus to the building and climbed the stairs. It was a much more reserved crowd. Not solemn but reserved. I found my designated table and body. Another member of my team and I unzipped the bag and unveiled our first patient. Out of respect for my first and perhaps my most important patient, I will not share further details about her. Before we covered her back up, my partner had stepped away for a moment and with foggy vision I thanked her for being the one that would teach me. For being the one that would make me a better doctor. For being my first patient.

Now, while nobody is watching, I can let a few of those tears loose. It was a deeply moving and powerfully spiritual thing for me. I touched her skin and pictured her, looking on from a better place, pleased that she will be giving us such a priceless gift. It will be an honor to learn from her. I will be eternally grateful to her. She is... my first and most special patient.

Day 1: Seriously???

So I thought it more than appropriate to report on the first day of the 1,000 + days that I'll be in med school. That first day was today. I shall now report.

I showed up one minute late and the entire classroom was busting at the seams with eager med students, eager third year med students, some faculty and a few members of the administration. I was forced to sit in the back. I hate sitting in the back of the class! It was apparent to me during my undergraduate studies that a direct result of me sitting in the back was laziness (usually nap time), restless leg syndrome, and texting. Needless to say, I was really calling on the higher powers to help me pay attention to the third welcome speech/ slide show I have had in the last four days. Sheesh! I feel welcome for cryin out loud!!

The "welcome" was mainly the history of osteopathy and a plug for A.T. Stills, the founder of my school and the master-mind behind osteopathy as a compliment to medical practices of his time. He was an amazing man and way ahead of his time. A major reason that I'm so stoked to be educated and trained as a D.O. is the philosophy that a physician ought to treat the patient and not the disease in order to heal for life. Basically, not being satisfied to simply mask and manage pain and discomfort, but rather provide a pathway for the body to heal itself and return itself to equilibrium. This is a spreading philosophy among M.D. institutions and many other health professions. Our bodies are totally amazing and we owe it respect!

After the history lesson, the proverbial poop hit the fan. As the brilliant biochemist, all-bright research scholar, fired away about acid-base mechanics and solution terminology, I was horrified. I can't believe how rusty the chemistry and organic chemistry have become while sitting in my little wrinkled brain. Looks like I already found the 1st quarter course that will punch me in the epididymas.

After the rousing BioChem lecture, we had a... yes, another free lunch! I haven't had this many free meals since being a missionary! It's all part of some plan to fatten us up before we completely destroy our bodies with energy drinks, lack of sleep, and study snacks. They are doctors for heaven's sake!

After lunch, things became even uglier. For those who don't know me really well, I am a self-proclaimed "recreational philosopher" who would have majored in philosophy and ethics had I wanted to start med school after my thirtieth birthday. We had a small presentation about the evolution of ethics and morality in a person as they become more educated and age. Then we had a comparison made between physicians, by specialty, on how they score on morality tests during and after med school. Orthopaedic Surgery Residents scored the highest and internal medicine folks scored. Nobody has any idea why. So why share the info??? Then the worst thing happened. We were given a standardized test that was going to score our moral compass, I think. See, that was the problem, there was no mention of anything beyond, "read these situations and rate the 12 issues as either of great importance, more importance, some importance, little importance, or not valid." As someone who takes the ethics and morals of people pretty seriously, I was flabbergasted as people were done with this test in a matter of minutes! Was anyone considering all points of view? Was anyone asking themselves about slippery slopes or universality of their choices? I doubt it. Was it super confusing as to how to rate the issues? Yes. Where the issues vague and poorly worded? I thought so. I just got worried that the ethical and moral issues weren't going to be addressed in med school as I would hope for. I'm probably being way too nuts about this but it got me warmed up for the final activity of the day.

We ended our first day in one of the most strangely performed patient simulator experience that I could have imagined. It was like a predictable movie. Our group of ten students, called our society, was divided into two groups and we stood awaiting instructions outside two patient simulator rooms. We were handed a clip board with the patient/situation information for us to read aloud. The smug second year student was dripping with snooty-ness as he clearly knew something we didn't. After finishing the reading we were pushed into the room and there were two attending physicians standing over the rubber body of the patient. The only thing they said was, "What do you do now?"

Taking all things into consideration, our first year of med school is infinitely better that KCOM is exposing us to clinical situations from our first day rather than wait till our third year rotations. Patch Adams would love this school! But what the heck does a first year med student know on their first day? One of the guys in my group was a music major. What on earth was he going to know?? !!! I know they weren't expecting much but our group had a pretty cool couple of attendings and they made the experience a very educational one. What got me all riled up was what happened in the debriefing meeting afterwards.

The other students in our society asked us if our patient lived or died. We had no idea how to answer because as we progressed through the methods of diagnosing the plastic man and then worked out treatment options for him, we were called out for the debriefing. They were a little unnerved at the fact that their synthetic patient bit the dust (some one turned him off). They didn't seem very "educated". During the debriefing we analyzed what we could have done better. Of course, being the smart-ass/sarcastic person that I am, I wanted to say that being doctors would have been super helpful. But it was good to look back and see how much stuff I have learned in undergraduate, scouting, and even lifeguarding that helped me so pretty well in the simulator. I just think they should have prepped us better to role play. How can I answer the question, "How does he look?" when all I see is a very unconscious rubber man on a hospital bed? My only answer was, "He looks like he may need to be rebooted." It got a laugh, mind you, but I want to be a serious doctor, not a class clown. But it is impossible to be serious when they play the "look how little you know you little med students" game. I'm in school to learn this stuff. Surprise!! I imagined trying to make fun of Bostyn when she starts learning to read. "HA HA! See how you can't read now! Bet your excited to learn so you don't ever have to feel like an idiot ever again!" I'd put the other groups experience on the "ineffective" list.

Never the less, I am even more excited to get things going in school. I talk pessimistically but I hide the much more prevalent optimism cause you already know that I'm excited!!! I've been waiting to be a doctor for as long as I can remember! I just like to be a critic.

I just filled out my seventh freaking survey and I'm going to bed! I finally get to wear normal (non-suit and tie) clothes tomorrow. I'm totally wearing a wife-beater and some jean cut-offs tomorrow. See if they ask me any questions then! Laters.

Some Pics!

Here is a small taste of the white coat ceremony. I need to lose some hair or go grey to be a respectable doctor. I pray for the latter. :)

I dawn the mystical jacket of healing.

A beautiful but tiny woman meets me outside to congratulate the student doctor.

Another beautiful woman joins her.

I am surrounded by some other people that happened to be there too.

This was the scoreboard in the gym where we had the post-ceremonial picnic. Class of 2013, 172 students in the class, 1st year. Neato!