Apr 28, 2008

Inclusion bodies?

Sorry about the comments lockdown, guys. Had a troll infection. Now, my only question is whether trolls produce inclusion bodies in the cytoplasm or the nucleus, and if it's the cytoplasm, can you see S-100 dense core granules using electron microscopy?

I'm also a big fan of EM for the cool factor, and it's one of those devices that while I've never been able to use one, given infinite time and money, I could probably play with it for months, much like I could play with agar plates given sufficient quantities.

Today (well, yesterday) has been one of those rare productive days where I can't rattle off lines from season 347 Simpsons episodes so in turn I may rattle off etiological agents that cause your brain to turn into goo. This is fitting because the brain-goo micro lectures timed perfectly with 500 slides in three lectures worth of brain-goo, so the studying becomes the symptom. Oh, and don't go anywhere in the world. If you do, don't eat, drink, blink, or breathe anywhere or your meninges will explode, but we already knew that from parasit, and honestly, having my brain erupt is a far more attractive prospect than ascaris. Virtually anything is.

Also, why does everything need to suddenly focus on Venezuela when I'm planning on heading there in December? Border conflicts weren't enough, but now suddenly everything's endemic to it too? Ick. Who'd have thought that planning a hike through rainforest could harbor so many pathogens? Oh wait. Though honestly, after micro, who'd have thought the Arizona desert would harbor so many pathogens? You'd think all you could get there is skin cancer, but no.

After that came a crash course in HIV infection. Apparently, the original blame has been shifted from the long-maligned green monkeys to Bobo, the AIDS chimp. This is going to make it a *lot* harder for Jane Goodall to save them.

Apr 26, 2008

Much love, Dr. Cockroach

After much deliberation over the horribleness of planting aspirated cockroach imagery in my mind, after taking in the lung cancers lecture, I've decided to put our differences aside and like Dr. Cockroach, though I will be bitter enough about the wriggling nastiness to dub her Dr. Cockroach, but the love is there, I assure you.

You see, fourth term, I had forgotten what it's like to have someone, even a guest lecturer, seem to be genuinely on our side to *teach us the stuff we're supposed to know* and NOT out to punish us for the decision to become doctors, which has seemed to be more the norm this term.

Weird part is I like a lot of the material in fourth term; a LOT better than second term (I like Dr. H just fine; I just REALLY don't like physio unless something's malfunctioning in it), actually, and I'm doing decently enough. I just feel like there's an us against them situation where we must be forced into their learning model, have time wasted with busywork, and then have them devise questions where even when I know the correct answer, the question is jerky. Like some footnote in the notes mentioned once and glossed during lecture will be a question on the test that I only get because it was a diagnosis on House, so it stuck in my head. Those sorts of questions.

This feeling was also stressed by our "introductory" packet, that included a cutely patronizing and wrongly attributed poem about students getting what they deserve because they complain to the professors about getting shoddy or incomplete notes. Hardy har har. I'm working hard on my response to it. What rhymes with "Pretentious, self-congratulatory nonsense?"

The presence of someone working in our best interest not only brings out the appreciation of her, but an appreciation of what *could* be the course. Maybe we could convince her to make the switch. The weather's pretty much the same here as in SC, the cockroaches are approximately the same size, but I haven't seen them fly ("palmetto bugs", my ass) and we get fewer hurricanes.

Apr 25, 2008

And I thought I had problems before...

Medical school is stressful, pretty much by definition, so I have a constant influx of school-related stressors that keep the bile and gastric acid contents at full boil, a thud in my step, and a hang to my head.

But that's all good... I've gotten used to it. Well, except for the recurrent attacks where I feel doom suddenly closing in on me.

So I'm watching path on Sonic Foundry before bedtime... and the professor is talking about aspiration... and how the cockroaches get so big in South Carolina (I can attest to that), and have no qualms about crawling on you while you sleep... especially if you're poor, like medical students are (her emphasis, not mine), and if you sleep with your mouth open, they can just crawl right in and you can suck one into your right lung. There's a picture and everything...


I'm torn, because I like this woman as a lecturer a lot, yet after placing that image in my mind both conceptually and visually, and I already have sleep problems, she may be contributing to my imminent psychological breakdown.

Though aspirating a cockroach STILL might be better than studying micro.

Apr 24, 2008

Lungs... filling with neutrophil elastase... send help...

Yeah, that's pretty much the story of my life. Updates you ask? I got your updates right here... IN MY PATH BOOK! Where I'm spending a great deal of my time!

Oh, when I'm not panicking about micro, or occasionally, Physical Diagnosis. It's out to get us too, and I think "I could be living in a commune up near mendocino round now *pretending* to be a healer, and I'd make more money. But I don't think they'd let me eat meat.

So what was on the menu tonight? PD lab where we got to strip the menfolk and dig our fingers into their nips to try to palpate their apical angles. Path lab was more of the same; fighting with the tutor. Don't feel like I know anything this week, but am trying to catch up as soon as possible. Also feel the meds working, heh, so be prepared for that.

Micro has just become compulsive about ways to waste our time; they're just really working on it, and it's infuriating. I'm in the midst of arranging my Prague housing and instead I'm dealing with bussssywork. And the term is already buuuusy!

But we shall overcome, eh, comrades! So much forward on forward march and all.. so in the meantime, I'll entertain you with a video that I found funny, even if I was drugged and sleep deprived at the time.

Apr 21, 2008


Studying pictures of ocular pathologies for my clinical skills quiz tomorrow is making my eyeballs itch.

I also got the distinct pleasure earlier of being able to utter the phrase "it's not lupus" and mean it! House fans in the audience?

In other news, I survived a night hash, got to do the last leg hanging out of the back of a pickup truck due to some remarkably good timing at arriving at the free-drink place down by Food Fair, discovered that Banana's is TRULY unreasonable about the timing of the conversion of the game room to a stupid dance club (RIGHT in the middle of our dart game!), so topped off the night by playing blackjack at my place. Forget them; I was losing at darts anyway.

Got to hash with Becky, who was a hash virgin, whom I got the distinctive pleasure of naming "Truckstop" (see above), but did NOT get to drench in beer in the initiation. What up?

In other other news, I haven't caught up in path and micro yet, but I'm still gonna go with "worth it!" And I did manage to get through three of the micro GI lectures, but there are so many disgusting critters and so little time.

Apr 16, 2008

Letters Home

Dear Mom and Dad,

Grenada is nice. I'm making friends with lots of the locals:

School is going okay. I think I finally found a study strategy that works for me:

But I do worry about the effect that it will have on my next exam:

I'm keeping up in path lab, but it's difficult to deal with the overcrowding:

Though the path tutors keep a watchful eye on us:

They still really give you the feeling that they view you as equal colleagues fully worthy of their respect:

Still, despite my progress, and though Grenada's beaches are nice:

It all leaves me feeling well, kind of like this:

So, I've still decided to buy a boat:

And instead of medical school, sail back to Puerto Rico:

Where I can apprentice under the world's fastest bartender:

After a couple years, I'll be heading to Anguilla:

to open a bar of my own:

I've already okayed it with the highest government offices in Anguilla:

I figure, even if it doesn't work out, I can always become an airline pilot... or a short order cook. I'm not sure which:

As always, I love you guys lots, and please send money.


Oh, P.S., when you send the wire transfers, please send it to "Esmeralda". I'm going to have to change my name to avoid my student loan creditors:

Apr 14, 2008

Dr. Acula, at your service...

Or MS2 Acula, to give my actual rank, but then the joke doesn't work!

Today felt like a *real* medicine day rather than a "Let's see how much we can cram down your throat and then test you on further minutia we barely touched on".

First was physical diagnosis lab (not including those lecture things I've heard so much about), where we got to peer at each other's ears, nose, and sinuses. Patient interviews are fine and all, and yield less testable material, but I do sure enjoy this way more, because you get to learn how to make your friends feel insecure about their minor asymmetries.

It was also a fairly short lab, allowing me to run to the bookstore just in time to realize that the "pen light" I'd been planning to buy was actually a keychain. Doh.

Path lab took a turn from "go through intense amounts of material while presenting slides" to "no new material except stabbing your classmates, looking at your blood under a microscope, and confirming your blood type." Yup, still A+. Always good to have that backup info.

So got my stab on, and since you stab members of your group, you get to see your handiwork the next day, so I hope I didn't leave too big a hematoma on my lab partner. For me, I've got two new holes in my elbows, and I can say they were done with a lot more finesse than my second to last professional blood draw before I came to SGU. I think that chick nailed an artery. Or an artery wrapped around the nerve. Or bone. I don't know what she was doing. Neither did she.

Then, in case the day wasn't going well enough, we got to meet with some people who did the Prague selective and get some more info. OH, for a chilly summer! And a bike ride to a castle church. And dollar beer! And Medieval restaurants! The list goes on and on. Still scoping out places to stay, hopefully in Prague 1. Need more roommates!

In other news, I'm STILL behind in micro, and need to do some blood stuff for path. But this term does feel like real doctoring, I have to say. Well, until test time. Then it feels like battery.

Apr 13, 2008

Procrastination compensation

Making flashcards for 40 pages of path cardio notes goes down about as easily as drinking ground glass.

The problem with a packet that has 60 pages of notes is there is no natural "AHHHH" stopping point as a rule, thus you're forced to enforce arbitrarily time deadlines to keep your brain from giving up and checking the internet for new stuff every five minutes, or, in last night's case, flipping channels aimlessly until you pause at the Jack Black production of King Kong only to realize the entire first half of the movie has been cribbed almost directly from Jurassic Park and Congo, so you give up. Sorry, Peter Jackson. LotR was awesome though...

Speaking of things with large sharp teeth, tomorrow is going to be micro day, and the closing arguments of identifying respiratory infections by whether the invading virus has positive or negative sense strand RNA is the ONLY thing that could path look wonderful in comparison.

Oh, also Nina's b-day. Happy birthday. I cannot imagine the horror of having my birthday fall anywhere near fourth term. Ick. We'll be hitting La Belle Creole tomorrow for that couple hours between studying and studying.

I'd blog further and add in more trip and ship details, but if I don't get these congenital heart defects polished off tonight, I'm never going to. Why, oh WHY did I refuse to learn any embryology whatsoever during first term???

Oh right, they combined it into anatomy so you could conceivably ignore it and still pass. Hooray!

Still, philosophically not as bad as making behavioral science, ethics, jurisprudence, statistics and epidemiology one class though. "Hey! These subjects have nearly nothing in common. Let's conglomerate it and give it some weird PC jargon name so when these students are going for residencies, they have no sign of having taken any of them on their transcripts."

Apr 12, 2008

You know you're procrastinating when...

As King Kong takes on the THIRD simultaneously attacking tyrannosaurus rex, you think "You know, this movie isn't half bad..."

Also, as far as terrifying goes, maybe it's the strong primatology background with my anthro major, but considering how creepy and horrifying those natives were at the beginning, if they'd kidnapped me after I'd watched them bash in the brains of my colleagues, the fact that all of it was to the end goal of throwing me to a giant gorilla would have come as something of a relief.

Apr 9, 2008

Now I can skip pharm

Thanks to Sarah bringing this to my attention, I think I just got the whole course in under 2 minutes:

Microbiologists are out to get you

So there's rubella, rubeola, and now, rubula.

They also featured typhoid fever and typhus, two disorders related in having absolutely nothing to do with each other.

My question is, since unlike fields like philosophy, and my original love, physical anthropology, microbiologists actually work in an employable field, why the hate, guys?

Apr 7, 2008

Out of the frying pan

And into the "What? Why are you making Clinical Skills hard?"

Midterms are over! Woot!!!!! Which leaves me sorely behind in my bathing and blogging. Those are the first two to go, next to shopping of course. So do I go over the redeemed birthday trip going island hopping? Do I talk about how good it felt to have a weekend without anything ostensibly due? Do I post a synopsis of Sunday's boat trip out to Hog Island? Do I lament the fact that though they seem to indicate the micro test grades are up, they aren't, though they apparently did toss some questions (CELLLLEBRATE good times, come on!), leaving me to pathologically hit "refresh" on Angel all day?

I suppose I'll start with the academics, throw in some vacation pictures, which I've been meaning to do but haven't had a chance to, and perhaps dabble in the boat ride... oh, and the Aquarium party on Friday night... jeeze, what's a blogger to do? I still don't think I've finished my Venezuela trip.

So exams went well, though I won't know that until the micro grade is in, but I don't feel as godawful about that exam as a lot of people, nor as godawful as I felt about path, which I still passed, so wahoo.

I am going to sing anthems to flashcards though, because though my grades aren't in for micro, I know that the majority of points I scored were flashcard points, including one question that I got on the BUS RIDE TO THE EXAM. Now *that* is some luck right there, and thank goodness, because all that virus stuff has already fallen out of my head. To think I once wanted to be a virologist.

The exam felt more straightforward and seemed to balance some ridiculously easy questions (wash your hands!!) with some ridiculously hard ones, but had a nice enough balance that I didn't get that mid-path exam sinking feeling of "Holy crap; I'm hail mary guessing on half of these". I spent the minutes before the exam sitting on the floor with my knees to my chest hurriedly moving through flashcards as I had earplugs in. Weird part is for path, I was pretty calm going in (sort of) and had more of a seize up during the exam, where I was completely running around in circles before micro and then felt calm and collected during the exam. Who knows?

Prior to the micro exam, I did get an illustrative example of everything we've learned in class by making the mistake of patting a pothound on the head on my way to sit down to do my last minute study. Said pothound then strolled over, started slobbering ALL over my face, including getting a few well placed slurps directly onto my mouth. Mmmm unvaccinated dog herpes. That's gonna be a board question!

Coming out of the exam, I met Dave at Pearl's who was ready and waiting with two wine coolers for Lori and me and a nonalcoholic beverage for Nina. Believe it or not, he came with traits like this when I met him!

He's also the reason I have pictures like:





Not to mention getting to eat the most awesome guacamole burger in history at the Puerto Rican Hard Rock Cafe. Mmm...

For anyone contemplating a long layover in Puerto Rico, DO IT. The old town (where all these pictures were taken) is within 20 minutes cab ride of the airport and they have it pretty tightly arranged. If you note the iguana, this was also a sore point for me started by American Airlines that Dave made up for. You see, I was scheduled for a 6 or 8 hour layover in San Juan at the end of first term. The plane was delayed so late that I missed my connection, spent hours in the Grenadian airport, and only got to see Puerto Rico as the sun was setting and had to stay in the airport to wait for my (also delayed) plane. AS the plane from Grenada to Puerto Rico was touching down and I was staring angrily out the window, all I could see were TONS of iguanas on the grass near the runway, which I'd been dying to see. I mentioned that I really wanted to see the iguanas as Dave and I flew back to Puerto Rico and the flight attendant politely laughed. I realized why when we got to the fort. The place is crawling with them! This was stop one on our island hop, and we started off very proper in history by touring the fort, wandering by city hall, wandering through Old San Juan and seeing all the sites:

Then, of course, logic prevailed:

Apr 4, 2008


I'm running out of titles that are synonymous with "AHHHHHH!!!!!!!" so I'm just starting to make up words, much in the same way that the micro department is making up drug names.

Okay, they're not but man oh man if I ever make it to pharm, it's going to KILL me.

So in the final countdown before the exam, I'm just trying to make up impromptu mnemonic devices (the three inhibitors of the 50S ribosomal subunit are Macrolides, Lincosamides, and Streptogramins, which Murder Large Subunits" to attempt to carry my worn out, overtaxed short term memory through the exam.

Incidentally, this tactic is also how I once got an "A" in college German and two weeks after it ended, couldn't say anything but "Welcome to Germany!" which has somewhat limited usefulness. If it does pull me through micro even though I burned out half the circuits in immuno, having to relearn it from scratch for the boards should be a peach.

On the plus side, I managed to get through all my week one flashcards while watching the sunset off the point and alternately feeding my half cooked chicken roti to the crabs. Salmonella reduces exam performance, particularly since these guys are pretty harsh on the bathroom breaks, the course directors, not the crabs; I don't think the crabs care.

I'm also loving the making of flashcards. Why? Because "Weeks 1-3" Ishie was INFINITELY more responsible than "Weeks 4-5 Ishie", which means "Weeks 1-3" Ishie made a buttload of flashcards for "Last Minute Panic" Ishie to be able to go through rather than trying to reread all the lecture notes.

Well, back to it. 8 hour countdown...

Apr 1, 2008

Oh now come on

Ah, baby's first path exam and can I just get a "hooooo my god" from the audience? Thank you very much.

Fourth term at SGU, as most of you may know, has a reputation for being a killer nasty horrible amount of work that leaves you ten years old at the end of the few months you have to learn about everything they ever talk about on House. Tonight, I went over for split pea soup and brownies (not mixed together) when they said the word "sarcoidosis". Keep it to yourself, Hugh Laurie. I don't want to hear it today.

Path was... hmmm...

The funny thing is that I feel infinitely worse about my scores that I did last night when I was way more stressed about taking this exam but had worked hard enough that I was sure I was going to nail it, but just didn't like the final countdown.

Now I'm like "Well... uh... damn" BUT I feel SO much better simply because it's over. I don't even care what I got on it. Okay, that's not true, I care a little. And I need to muster up some more care for micro on Friday, because I'm like two weeks behind due to studying for the monstrosity they gave us today.

Test was first component of slides. I did my new exam-stress little "first 10 minute feeling of fainting no matter what the difficulty of the material actually is" thing that I've developed in place of stress-induced insomnia. Basically, it works like this: I start the exam and get through between 3-5 questions. Regardless of whether the question is "You are studying to be what profession?" or "There are 200 possible mutations of the BRCA genes. Name them.", I feel really light headed and get to put my head down attempting to be covert in a manner that doesn't suggest fainting OR cheating. Then, I get to suddenly break out in an intense sweat that causes me to smell like feet, while smearing forehead material on my desk. Then, again, regardless of the difficulty of the exam, I'm fine, and the only thing I've done is make all my colleagues think I'm out of my mind, and overwhelm whoever's sitting next to me with the sudden strength of my transudate.

So it's actually working out okay for me. Have I mentioned that medical school takes whatever small idiosyncrasies you have and magnifies them to the nth power? So if you have little periods of depression, you're gonna develop major depressive disorder. If you're moody, you're going full blown bipolar. If you have a cold, you're going to develop lupus; just the way it works.

So that was for the slides. The weird thing is, I knew every single one of the slides. I had seen them before and could identify them in seconds. The other thing, was in a couple of cases, I knew what the slide was going to be before it even came up. So despite not feeling well, identification was the easy part since it consisted of glancing up at the screen for two seconds and going "uh huh. Liquefactive necrosis".

Problem being that for the most part, these were not the sorts of questions given, so I ended up writing exactly what the slide was, so I could go back later and figure out which interleukins were secreted from which cells causing which pyrogenic reactions that lay in the house that jack built from second term when I was hypothetically learning this stuff, which was the ACTUAL question. Not "what is this?", but "this is ________. Now... DRAW IT'S MOLECULAR STRUCTURE! MWA HA!"

After the slides, and this is the fun part, they give you long ass clinical vignettes where you figure out the causative agent behind the patient's symptoms, identify the mechanisms and morphology, and diagnose the patient, only to have them give it to you in the last sentence of the question and then ask you a weird esoteric detail of activated macrophages. Again.

Now, it took me repetition of typhoid fever versus typhus and mucormycosis versus aspergillus about five hundred times before I got them straight and could draw out most of their characteristics. Could you just ASK me that? I can diagnose a patient from 50 yards. After that, if I need to know what interleukins are being secreted, I can do what any doctor does and type the diagnosis into google and pick the treatment option that shows up the most hits so long as "FATAL" and "CLASS ACTION" do not come up as additional key words. Internet doctoring.

The most fun part of an exam is when an exam goes from puzzlingly difficult to ridiculously difficult, which is the point where it stops being stressful and starts being funny. At least for me. This was around question 90 when things dissolved into an oncogenic molecular pathology alphabet soup where I was looking at some questions going "Okay, it's possible and quite likely that I'm stupid, but the nature of this question makes me think that there's about 10% of the people here that actually know this and they've probably taken this class before." And the weird part is, the stress kind of went away. It's a beautiful moment where you stop thinking about 'maybe an "A"!' and you're all in it together to just pass. It's where you walk out of the exam and everyone is just grimly laughing, and planning to arrange into the same path groups when you inevitably have to call a do-over.

This is also where I really like my class. See, I love the 'grade' as much as the next person, but I'm not huge on the ubercompetitive bust others to head off the potential destruction of my "edge", unless I'm playing a House drinking game (Vasculitis!), and for the most part, while even being a solo studier, my class is one that largely seems to support each other, help each other, and so forth, with each other, even when stressed, and that is SO cool. We've got people posting tutorials, helping with path questions, giving tips, helping out, and I cannot imagine medical school without that environment because everyone is perched delicately enough on the edge.

So now, having taken that ego hit with path, it's time to figure out what those creepy crawlies that make your skin (and nether regions) itch are. By Friday. Or else.