Christmas Update!

Happy Holidays everybody!

I am so sorry that I haven't been able to take the time to add a new blog here lately. I have been feeling a bit overwhelmed with school from the Thanksgiving through the winter break. All is well though, here is the update.

We had our first exam in our new course right before Thanksgiving. It is called Cell Structure and Function and combines histology (looking at cells under the microscope) with biochemistry. It was brutal. The class average was a 75% (which is considered good for this class!) and, as has been my trend for medical school, I was right with the average. This was very disheartening for everybody in class. We felt like we had been hit by a Mac truck. On a more positive note, I got my grades back from my ongoing clinical medicine class and did really, really well. I am pretty ok with this since it is more likely that I will be dealing with patients in a clinical setting than looking at cells all day with a microscope. But anyway, the rough first exam set the stage for exam #2 which was on the 19th. I don't think I ever studied so hard for anything in my life.

However, it wasn't going to be that easy. Portland was hit with the worst snow it has seen in 30 years (basically your average, yearly bad snowstorm back east) and the city shutdown. The exam was on Friday and we started the week with Monday's classes cancelled (for 2 inches of snow!) Tuesday's classes went on, but the afternoon class on Wednesday was also cancelled. I actually skipped the am lecture that day (I rarely miss class) because I didn't want to risk getting stuck at school for a week! You see, my school is up on a hill overlooking the city. Windy roads lead up to the hill. Also, they are not allowed to use salt on the roads here (bad for the rivers) and they have to set the plows (which are about 30 years old) to two inches above the street in order to not damage the streets with their plowing. So, basically, all of their snow removal attempts are futile.

As the week went on, light snow continued to fall but the classes were not cancelled this time. The dean's office made contingency plans, which basically would have us taking this exam once we returned from winter break (our "vacation" would hardly be a vacation with this exam looming over our heads). Friday came around and we were able to take the exam! Relief all around. On top of that, the preliminary scores were posted and the average score jumped 10 points! Amazing. I was actually marginally above average, where I am quite happy thank you. There was much rejoicing that night! My friends and I (Courtney had work :( until late) went out to eat and ended up playing darts. Made me feel like I was back in Philly!

On Saturday, though, the real snow began to fall. Courtney had her winter dance recital out in Camas, WA that afternoon and I went with her to see it. The snow was really coming down hard and roads were being closed. By the time we got to Camas (a 25-minute drive from Portland that turned into an hour and a half drive) we had seen at least 4 trucks crashed into the side of the highway. People in trucks always seem to drive like fools in the snow, as if they are immune from accidents, while all of us in cars are afraid for our lives and drive cautiously. The result is predicable. The cars make it to their destination (or get stuck in the snow!) and the trucks wipe out.

When we got to her studio, we decided to drop off the costumes she worked on and turn right back around, which was really smart. The recital was cancelled an hour later and a foot of snow blanketed the region soon after. We were snowed in for days. Luckily, Courtney had made a grocery run so we were able to eat :) On Tuesday, there was a break in the weather and we needed to restock, as well as get dinner for xmas day and eve. Our car was still snowed into the carport and we knew the roads would be terrible, so we walked to the store. It was about 3/4 of a mile away. The walk was crazy. No one in Portland owns a shovel it seems, so there was no visible pavement to be seen. We were walking for most of the way on a snowpack that was 3 or 4 feet deep that had been plowed to the side of the road. Some people were getting around on cross country skis! Anyway, we made it to the grocery and it was a zoo. Everyone realized this was the time to get out, especially since the forecast was calling for more snow the next day. We bought everything in sight: meat, fish, vegetables, wine (you need something to do when stuck inside!) and then packed up our stuff in backpacks and cloth shopping bags to head home. We had spent over $200 and the groceries were heavy. Oh, and the walk was uphill. It was a nightmare. We stopped multiple times, Courtney had to use her inhaler, and I was sweating from the workout. We finally made it home and collapsed. Courtney had to take two muscle relaxers because her back was seizing up!

For xmas eve, we had a nice london broil and we exchanged our gifts. We both bought each other multiple sweaters...now we can actually be warm here! Today, on xmas morning it is snowing again and we miss all of our friends and family back east. Hope you are having a good holiday and we look forward to seeing you soon!!!

Thanksgiving

So today is the day after thanksgiving. It is a a really welcome break from all the madness that is medical school. I am so happy not to have to wake up at 6am in the morning everyday! Unfortunately, that is all coming to an end on Monday, but at least for the moment there is nothing for me to do or worry about.

So, Courtney and I had a very good holiday, probably as good as it could be considering we are 3,000 miles from our family on the #1 family holiday of the year. I spent the morning completing some surprisingly long computer based training so I can begin working at the VA Hospital next month. Once Courtney and Drac finally roused from their night's slept, Courtney and I went to the Ronald McDonald House to volunteer for the 1st part of the afternoon. We helped cook dinner for the 16 or so families that are staying there this holiday because they have a sick child at the hospital. We were in charge of the mashed potatoes :) We didn't get to meet many of the families, it turns out that the zoo was giving free admission on Thanksgiving so most of the families were taking advantage of the distraction. However, we did get to see some rambunctious kids running around and it felt nice to do something for someone else on the holiday.

After making the dinner, and coming home briefly to decompress, we went out to dinner at a restaurant around the corner called 3 Square Grill. It was absolutely delicious! We had our turkey, of course, but we also had two different stuffings (corn bread and oyster) as well as delicious potatoes, cranberry relish and a wonderful ginger cake for desert. Courtney said she never ate so much in her life! Well, she paid for it later with a tummy ache that is still hanging on today. Oh well, I guess that is the price you have to pay sometimes.

Anyway, hope that your holidays went well. I am steeling myself for the last few weeks of school before holiday break. The new class is brutal. Just had an exam on Wednesday, and the class average was a 75. That is where I was (I seem to always get the class average!) after studying for it for 5 days. Just doesn't seem right, no? Anyway, we have another exam in this class before xmas break and that is it for a while. I have to start keeping a journal again starting next week, so be on the lookout for some more "healthcare themed" blogs coming your way.

Random Thoughts

I just got back from a conference in Vegas. Honestly, I don't think I ever thought I would attend a conference in Vegas, but there I was! Anyway, it was very good. I represented OHSU at an information session and also took part in a pharmfree conference. It was fun and energizing, although I personally have no taste for Vegas. It feels like a soulless place to me.

We have our first test in our new course, Cell Structure and Function, this Wednesday...the day before Thanksgiving. I am not sure how I will handle integrating this week's lectures before the exam, but I guess I have no choice. I am looking forward to the mini-vacation that will follow the exam.

That's all. It is late and I need my rest. All free time is dedicated to studying until Wednesday's test is over (except for brief mind recovery periods, like this one, so I can be more efficient.) I will post something next weekend that is a bit more fleshed out, I promise!

Stem Cells

We are learning about stem cells in class right now. From what I understand, it looks like you could take a person, plop them into a vat of some solvent so that all of their cells melt away, and leave their connective tissue behind. Then, if you just added some of their stem cells you had saved, VIOLA! You have a brand new version of the same person! Perhaps that is a bit of an oversimplification, but that is what it seems like.

Healthcare Reform

Barrack won! Now we will all be able to afford our healthcare right? Maybe not.

Do we all get universal coverage? Not so fast. Beyond the obvious labeling of our government socialist by people who are in opposition, just take a second to think about the ramifications. According to data we saw in class the other day, about 25% (give or take) of your hospital bill is spent on administrative fees, that means this money is going to someone. Medicare has a much lower overhead, somewhere south of 10%. So if 25-10=15, than that 15 has to go somewhere (and not just into some rich CEO's pocket.) That extra 15% is going to support people who work at Blue Cross/Blue Shield, Aetna, etc. It is also going towards keeping the extra administrative staff at the hospital and doctor's office employed. So, the biggest ramification of socializing the system is that it would have the immediate effect of putting a whole bunch of people out of work. That is not such a good idea, especially in the middle of a recession.

One of the other big problems we have is cost. By now, most people have heard that most of medical expenses are spent on critical care during the last two years of life. So, what would the option be? Deny grandma an medical treatment once a doctor deems that she is not worth it? You can just imagine the uproar. But perhaps that is too harsh of an assessment. Maybe grandma doesn't really need to see so many specialists at her age. There was a landmark study done by Dartmouth a couple of years back comparing outcomes at top teaching hospitals in the US. It looked at what they spent on the last two years of a person's life. There were some big differences between Mayo Clinic and Mass General, specifically. They were on the order of hundreds of thousands of dollars per patient. To top it off, the outcomes were no better at Mass General (who spent much more) than at Mayo.

Personally, I feel like I am seeing this in action right now as I work with my urologist out in Oregon. He is very sensitive to the practical considerations of whether it is advisable to treat a patient given their age. If someone is 85 years old and appears with prostate cancer, it is not something he is concerned about. That might sound cold, but the reality is that they are not likely to die from that disease until the are about 105. Would other doctors treat this patient? I am almost positive they would. Should they?

Finally, the last part of this problem that is on my mind is the purpose of the healthcare system in the US. A lecturer we had discussed the "mission statement" of the US healthcare system. He went on to say that if the mission is to generate profit, than we are succeeding marvelously. However, if it is meant to provide for the public health, than it is an utter disaster. I think that this is a discussion that needs to happen. For comparison, we don't have for-profit fire fighters. We used to. If you go to look around olde city in Philadelphia, you will notice that there are some placards on the front of the townhouses. These placards were purchased from local fire companies and, if your house was on fire, they looked for the placard. If there was no placard, they let your house burn down. This is how the healthcare system is working today. If you have a raging inferno, than they will treat you in the Emergency Room, but they might bankrupt you as a result. If you have a slow fire burning, say a cancer, they are not forced to treat you at all. Addressing this mindset is key to reforming healthcare in the US in my opinion.

So basically, there needs to be: a solid plan in place to prevent not send millions of people to unemployment, a serious study of various health systems (both in the US and internationally) to learn how to handle costs, and some hard discussions about idealology and purpose. If these things actually happen, then I will be hopeful.

Sex for Octagenarians

**disclaimer, this is not an actual patient account, but a collage of various experiences with names and specifics changed to protect health information.

As many of you know, I have been spending the past two months working with an urologist here at school. This has been a surprisingly rewarding experience for me, and I am a bit sad that it is coming to an end soon. Most of our cases that come to the office involve urinary tract infections, kidney stones, prostate and bladder cancer, or various "itises" that are only inflammations but are presenting themselves as if they maybe a more serious affair. In addition to these cases, we also get our fair share of erectile dysfunction. Now, it is one thing when the patient presenting with erectile dysfunction in their fifties, however, when they are well into their eighties, it is pretty amazing to me.

There is so much in the news today about therapies, pills and exercise programs that we can do in order to live longer lives. However, when I see a many of these older patients, it becomes crystal clear to me that a longer life is not better than a quality life. After a day of seeing a number of elderly patients in poor health, the urologist I work with asked me, "So, how old do you want to live to be?"

You see, most of the people who show up at the office who are in their eighties are not thinking about having sex with their husbands or wives (or girlfriends/boyfriends, for that matter!) These people are generally concerned with trying to be generally free of pain and discomfort, or are really just trying to stay alive. Some people, when asked about their sex life, haven't had one for years, even though they are still married. In addition, a good percentage of these patients are not as sharp mentally as they used to be, so the physicians are really just trying to patch things together and trying not to make a bad situation worse. Now, to be almost ninety, be of pretty sound mind and body, and to have erectile dysfunction as your chief complaint? That is something that many of us can only hope for.

And that is where the 80-something year old guy comes in, let's call him Mr. Jones. My hat is off to him. Mr. Jones is basically of both sound mind and body (more or less). On top of that, he is still able to maintain an intimate relationship with his spouse (in this case, a re-marriage going on twenty years). What a life! His quote to me? "Sometimes the wife still likes to play around." It is a cute way to say it, but I feel like it was very sweet. Maybe like the x-rated version of the feeling you get when you see the older couple going for a walk and still holding hands.

My answer to the urologist about how long I wanted to live? To live as long, but also as well, as Mr. Jones. That is clearly the way to go.

Take an Acting Class

Ok, so anyone who knows me understands that I always like to shake things up. I don't know if OHSU was really aware of that when they decided to offer me a seat in their incoming medical school class, but here I am! My latest gripe has to do with how we are being taught to interact with patients, get their histories, and show empathy. It is not that I think we are being taught bad or incorrect things, I just feel that the class structure is putting the horse before the cart. And I think that this is problematic.

The latest criticism of mine is centered around a technique we are learning which is called the BATHE technique. BATHE stands for: Background, Affect, Trouble, Handling, and Empathy. This is a simple acronym that we are keeping in our heads to help us elicit a better history from our patients and better get to the root of some of their problems, particularly problems that are presenting themselves physically but have a psychological root (stress, anxiety, depression, etc.) This is a really good thing! If more physicians had the time and capability to implement this strategy, I'm sure that many patients would be helped.

Now, our teachers have of course pointed out that this is a rather simplistic and robotic way to interact with people. If you followed along these steps exactly, you are likely to sound more like a robot than like a physician. And this is what gets to the root of my problem. This "checklist" is, I think, the second step in the conversation, not the first. Maybe it is my theater background rearing its head, but I believe that it would be more helpful to start with an actual workshop on listening. This is a key first step in improvisation acting, which is what we are doing in a sense when we are interacting with our patients.

Now, we did start the semester by talking about the importance of listening to our patients. But, the thing is, we never truly worked on it. We never had an instructor (in this case, I would argue the instructor should be an acting coach, not a doctor) insert us into situations and have us work on listening and reacting appropriately. When you are truly listening, your thinking is different, your being is different, your physical presence is different. To say to yourself that you will listen does not mean that you are. Every half decent actor knows how to listen, but I am not convinced yet that most doctors do, and I believe that most Americans can agree with me on this one.

I feel like our classes are trying to get to this place, but it isn't there yet. We do "play act" with each other, but it does not remotely compare to the intensity of the real thing. If we don't all learn what it truly means to listen to our patients (and to each other) than taking part in something like the BATHE technique will just be window dressing, and the patient will see it for that. Learning these skills are hard, and I think that the time needs to be devoted to these fundamentals. We all could use the practice.

Pharm Free

Next week in National Pharm Free week, and I just found out a few days ago that I will be the coordinator for the activities at OHSU. It is a little crazy, but it looks like we are going to pull it off.

Let me start by saying that "Pharm Free" is a terrible name. It implies that you would like to treat all of your patients without the aid of pharmaceuticals. Obviously, this is not the case (would make being in med school pretty hard, no?) Pharm Free is all about reducing the influence of marketing on the physician/patient relationship in an effort to bring down the costs of pharmaceuticals (and healthcare in general) while also working to restore some of the physician/patient trust that has eroded over the years through the "business-ification" of medicine.

"What is wrong with business and making money?" you might ask. Well, nothing really. However, the relationship between physician and patient is supposed to be about something more, from what I both understand (and am taught weekly in my PCM course) and what I aspire towards. People come to a doctor's office, often in a very vulnerable state. They share with their physician some of the most intimate details of their lives...heck, they are already sharing these details with me and I've only been a medical student for a month and a half! As a result, I feel, and I am constantly being taught that, a physician's role is supposed to be to "Do good" not to "Do well."

In society today, we are constantly exposed to images that go against this basic premise. This serves to undermine this delicate and all important trust. TV reality shows are full of doctors anymore who are seeking both glory and a fat paycheck. The media latches onto stories about irresponsible and sensational doctors (e.g., "Patient sues doctor after he cuts off man's penis!") And our expensive medical bills cause all of us to wonder why some doctors are making over $500k a year, while their patients are filing for bankruptcy. Also, the current role of pharmaceutical companies in patient care is a constant specter hanging over the state of medical care in the US. All of these problems are substantial and eat away at that basic trust that must exist between a doctor and a patient in order for medical care to be effective.

Pharm Free Week, is simple but profound grassroots initiative that addresses one of these problems. We will be working during the week to have medical students sign the Pharm Free Pledge (http://www.amsa.org/prof/pledge.cfm). This simple pledge will plant the seed in the minds of future physicians that it might not be in their patient's best interest to accept that free lunch, golf trip, or conference in the Bahamas, from a Pharma company. I believe that most, average people see these perks for what they are: bribes. That is unfortunate. That eats away at the physician/patient relationship. That helps to reduce the effectiveness of medical care in this country.

In addition to taking the pledge, we will also be handing out stickers so we can "liberate" the drug pens that so many healthcare workers use to do their work. While it might not be like your doctor walking into the examination room with a big "Prozac" sweatshirt and cap on, simply using a pen with that same drug name implies something. The patient needs to know that the doctor is 100% on their side, and not prescribing them a certain drug because they will get a "kick back" as a result.

Anyway, that is enough of me standing on the soapbox for today. Here is the Pharm Free website if any of you out there are interested and want to make a change in your own small, grassroots way (http://www.amsa.org/prof/pharmfree.cfm).

The First Exam

Well, this Monday afternoon is my first exam in medical school. There is a clear air of anxiety about us first years. In my personal opinion, the anxiety level was actually highest at the beginning of the week. This was the time when most of us realized that we hadn't been studying either enough, or efficiently, or both! The hand is what drove it home for us.

You see, this block we are learning the back and the upper limb. That means that we have to learn all of the muscles of the back, the shoulder, the forearm, and the hand. For most of these muscles, we also need to know their origins (the places they connect and have little movement) and their insertions (the places they connect and cause movement to occur), as well as their innervations. Add onto this a knowledge of the fascia, major arteries and veins, etc. and you can imagine that we are feeling overloaded. Oh yeah, and the course is called Gross Anatomy, Imaging and Embryology; so that means we have to read some basic x-rays and also know a whole bunch of embryology stuff too.

So, about the hand, it has 19 muscles for us to learn. We learned them all in one day. To give you a comparison, the forearm also has 19 muscles, which we did in 2 days. The shoulder and back have 19 as well (kinda crazy coincedence, huh?) and that was spread out over even more lectures. So, when we got to the hand we all felt overwhelmed. For example, there are the flexor pollicus longis, flexor pollicus brevis, extensor pollicus longus, extensor pollicus brevis, abductor pollicis longus, abductor pollicis brevis, adductor pollicus and opponens pollicus. Eight muscles just to move your thumb!

I feel like my brain is going to explode. I am trying to find solace in the fact that first year medical students historically do very well on this first exam. Still, trying to keep it all straight is a challenge.

So enough about academics, I have some interesting news for those more faithful blog readers (all two of you!) We have to keep a journal for one of our classes and this blog seems to be a perfect way for me to accomplish that. I will be writing about some of this principles of clinical medicine (i.e., actually practicing medicine) and how I experience them through this class and through my work with my preceptors. I'm sure it will make for some interesting reading.

Week Two

Week two is over. Because of the Labor Day holiday on Monday, we still haven't had a full week yet. Amazing. It feels like I have been in school forever, but there have only been 6 days of classes. We have learned more information in those 6 days than I have learned in most of my semester long classes from undergrad. Med school does indeed take over your life.

It is interesting to look around and see how all of us are doing so far. I am particularly impressed by the parents. How do they juggle all of this?

So, you want some good stories, right? Well, I don't think I have any wonderful narratives to give you today, but I can share with you some observations from the ever interesting cadaver lab.

1. Underarm fat looks worse on the inside than on the outside.
2. When dissecting the armpit, it is best to hold your cadaver's hand. It may feel strange, but it is better than letting the cadaver's arm drape around your waist (they have wandering hands!)
3. Superficial veins are superficial, not located next to the bone. (I got it pretty bad for making that mistake!)
4. People will give you dirty looks if you go into any common area wearing your cadaver clothes. This is a great way to make a bad impression.
5. Don't leave your cadaver clothes in the trunk of your car. Even more importantly, don't leave them in your friend's trunk.

Anyway, that is all I have for now. I have to go back and finish reviewing my flashcards for the night.

P.S. Getting tipsy and reading literature to your significant other late into the wee hours is a wonderful way to spend a night.

Week One (truncated)

So, today is Labor Day and I am finally feeling like I have a moment to work on the blog. It has been pretty busy so far, but it is certainly manageable for the moment. OHSU doesn't throw you into the deep end first. As a result, once our orientation was finished on Tuesday, they gave us a day off to prepare for class. We had lecture and lab on Thursday and Friday, but then it is Labor Day weekend...so we have Monday off to catch up if we underestimated the workload (or were just studying inefficiently). It seems like a very considerate way to introduce us all to the grind.

However, after today, the kindness ends. In the second week, we will add a second, semester-long, class coming where we learn our clinical skills and also work in a doctor's office. This will take up two precious afternoons a week, plus a minor amount of study time. I am finding Gross Anatomy, Imaging and Embryology (the hardcore, academic class we started the first week) to be manageable, but when the Principals of Clinical Medicine class is added, there will be precious little time left. That is how they get you in med school. It isn't that the material is so hard, there is just so much of it and not enough time.

So that is the summary of what is happened. Onto some details...

Cadaver Lab - First Day
On Thursday, after our lecture, we went down to work on our cadavers for the first time. This necessitated us changing out of everything we were wearing (underwear and socks too!) and putting on a pair of ill-fitting scrubs. My pair were made for a 6 foot tall, 300 lb man. The top is a very unattractive, button-up smock and the whole thing is maroon. I look like a blood clot.

We all got down to lab and proceeded to get gloves. I overheard people discussing double-gloving it and I followed suit. We went over to our cadaver, an older woman who is very thin and frail, and began to decide how we would proceed. The first order of business was to remove the skin from her back. Now, the thing is, none of us have done this before and none of us really know what we are doing. As a result, we had no leader. In addition, the lab book at our table was from five years ago, so the pages numbers didn't match, and we were given instructions in class that contradicted some of these instructions anyway! Needless to say, chaos followed. After making a number of unnecessary cuts, we finally started making progress. However, we had to remove the skin from the body. This is when I remembered reading that the number one dissecting tool is...your fingers. So, I dove in with my hand and proceeded to do separate the skin from the fascia. Soon, everyone in the group joined in on this gruesome task and we were successful, somewhat. It turns out we were not deep enough and had to remove all of this fascia and fatty tissue in order to expose the musculature. No worries though, we eventually got there. Being older though, our cadaver barely has any muscle left. Her lat muscles (the huge Michael Phelps swimmer muscles on our sides) were as thin as tissue paper.

After lab, I sat with some classmates at lunch. Few were able to eat right away, but I had no problem. Apparently, not everyone double-gloved, so whenever my friends went to eat their sandwich, all they smelled was the cadaver lab. Yum.

Keep Your Mouth Closed
On day two, we worked on exposing the spinal cord. This was an even more gruesome task than the day previous. Let's just say it involved chisels, mallets, and a tool called the "bone pliers." So, we were having difficulty actually removing the spinal processes (the little spines you can feel through your skin) and had the professor come over to show us. I was looking over his should and my mouth fell open in amazement as he started to expose the cord. At this time, a bunch of spray came up from our cadaver and landed all over my smock. Just a couple of inches away from my wide open mouth. The professor proceeded to tell me that this is why we keep our mouths closed when dissecting. Point taken.

Well, that is enough for now. I need to get myself going and do some studying. I will try to post again next weekend and summarize week two. It seems we are having a Bone-A-Thon up at school for Labor Day. It looks like days off are a thing of the past.

Mini Vacation at Cannon Beach

The madness is about to begin. In an effort to gain some peace before everything hits the fan, Courtney and I drove to Cannon Beach on the Oregon coast to relax and do nothing. Initially, it looked like it would be a big waste since it was pouring when we arrived. Fortunately, the sky cleared up in the evening and we had a wonderful time. Well, most of us did anyway. Drac hated walking on the beach because he hates the water. Check out the pictures!

The famous haystack rock

Drac trying to get away.

The dog had to be carried, initially, until he realized the other dogs didn't have their masters carrying them.

Courtney, very happy!

The lighthouse at Cannon Beach

Drac, aka, Dora the Explorer

On the ride up to the viewpoint at Ecola State Park near Cannon Beach

The viewpoint at Ecola State Park

The viewpoint at Ecola State Park

Ecola State Park

Photos from White Coat Ceremony

Dean Kendall Speaking

On my way to my seat.

Getting the short white coat!

With my buddy, Jot

With my beautiful wife

Don't Stop Believin'

So it has been a couple of very busy, and eventful, days since my last post. There are some interesting events I think some of you might enjoy hearing about.

Pub Crawl
Well, since there are still a few more days left of orientation, a pub crawl was organized for Thursday night. If you are are an OHSU student, there is no need to worry, this is a blog that respects your privacy so all names and identities are protected at all times.

Well, I thought it would be fun to tag along on this event, even though it really isn't my speed per se, and also take the wife. How many opportunities in our lives will we have to hang out with a group of absolute strangers who are together at such at critical stage in their collective lives? We started in a basement bar, filled with second hand smoke. There were at least 20 of us and, amazingly, none of us were smoking. I guess I shouldn't be shocked, since we are all med students after all, but still, this had to be the largest group of non-smokers I was ever associated with.

The night continued on, and the PBRs continued to flow. At the end of the evening, we found ourselves at a great karaoke bar near chinatown. All the OHSU students joined together in a rendition of Journey's "Don't Stop Believin'" (quite appropriate at for the beginning of the med school "journey", although perhaps a bit cheesy :) ) that was enthusiastic (perhaps a little too enthusiastic?) My night with the group ended after a group sing of Bon Jovi's "Livin' On a Prayer" which is Courtney and my own personal theme song, as my cousin Jordan can attest from his historic reading of it at our wedding.

The Orientation Gets Heavy
Now they are getting us ready for the our first class, Gross Anatomy, Embryology and Imaging. Basically, this is what med school is famous for, the dissection of a human cadaver. Rather than go into all of the details, I thought I would just include this handout that was given to us. It is called "The Gift" and it is from JAMA 276:854, 1996. It was written by a donor in the Chicago area in the mid-nineties.

The Gift

I am lying here in front of you now because of those doctors that saved me the first two times. They gave me 15 years I would never have had. Fifteen years to make things right with Elsie. To care for her after her stroke as she cared for me and the children those years when I was running around. Fifteen years to witness the births of my grandchildren. Fifteen years to spend time with my kids as I never did while they were growing up. Some might call that lucky, but I call that a gift. A gift from God, sure. But also a gift from those doctors. My body is my gift back to them.

As you examine me here in Gross Anatomy, I would like you to do a few things. When you look at the scars on my hands, remember I was a butcher for 45 years. When you examine my liver, remember I was a drinker. When you hold my heart in your hands, remember how I ate and my quadruple bypass. But most of all, when you are with me, learn, so that you too may be able to keep giving the gift that I was given.

Michael A. Grassi
Chicago, Ill.

White Coat Ceremony
I will post photos of this as I get them from Courtney and others. It was engaging, moving and humbling. The organizers did a first class job.

The day started out with a bit of a scare though, for our little family. When I got up in the morning, I took Drac (the dog) for a walk to get a few bagels. Drac does not like to go on this particular walk, because he hates waiting outside the bagel shop. So, when we get halfway up the hill to the store, he starts sitting down and trying to turn back home. Anyway, he never wins this battle, so we ended up at the store. I was keeping my eye on him as I placed my order, then when I was paying the bill, a woman came in the door and said the dog ran away! I proceeded to chase after him (he was initially just out of my sight) and watched as he crossed SW Burtha and SW Vermont, in a effort to get back to the house. Somehow, he made it (he did at least cross at the corners) and I caught up to him just before the driveway to our complex. When I went back to the store to get the coffee I left behind, the woman told me that he chewed threw his leash in less than a minute and took off. Someone is a very bad dog.

After that initial scare, Courtney and I got ready and headed off to the ceremony. Courtney looked quite beautiful and classy. She was also very helpful, as she has been all week, making sure that all of the details that I don't seem able to remember anymore are handled. I would be lost without her help.

As I said before, the ceremony itself was great, but the details are a little fuzzy. There was an army of OHSU handlers there to make sure we all went the right places and didn't screw up. I'm not used to having such an extensive support system. It was all a bit surreal. Our speaker was from the east coast, actually used to be a Dean at Jefferson in Philly. The Philly connection has been strong the past few days. The night before we found a replica of the Liberty Bell downtown in Portland, and at karaoke I say the Dead Milkmen's "Punk Rock Girl" which makes references to Philly. Anyway, the speaker noted his amazement at the restraint the parents in Portland showed by refraining from clapping for the individuals students and saving their applause for the end. This would never happen back where we were from. It was appreciated though, and the applause at the end was raucous!

So, that is it for now. I'll get those photos up as soon as I can. On the horizon, I see my blogging slowing down as the real classes begin. There is really no homework during orientation, so I can write away freely now, but I know this will change.

I'm an ARS(e)

Fun times at orientation (i.e., transition) today. We played some fun social games, thanks to Anita Taylor, one of the hard working people behind our orientation. In the first game, we discovered that our class contained numerous people: who are fluent in foreign languages, who can play multiple instruments, and who were djs (myself included!). There were also a couple who majored in aerospace engineering, joined the peace corps and have a private plane license. There is even one person certified as a yoga instructor! Pretty cool (and impressive) stuff.

We also got to play a game where we worked to identify our general areas of interest. Mine are ARS, which stands for Artistic, Rugged, and Social. Apparently, this information can be valuable to us as we decide our specialties. It is kinda wild that we are all already talking about specialties before we have even had our first med school class!

Oh yeah, and people cannot agree as to whether we will be studying 20, 30, 40 or 50 hours a week. But, for some reason, everyone thinks we will only be sleeping for 7 hours a day and that we will have 17 free hours a week. I don't get it.

Anyway, it was a good and fun day all around. I have to do some reading tonight (my first homework) and I also need to fix my bike brakes if I plan on surviving another commute down the hill.

And on the second day, the Lord created Politics.

Well, the orientation continues, and there were some very interesting, and some not so interesting, aspects to it today. During the less interesting parts, I took an opportunity to skip out and get my id badge. As a result, you will be spared some of the details about how to use Outlook for email (1 hour long...I swear!)

The day started with a primer on Financial Aid. This was a talk that would have been helpful BEFORE we all signed the master promissory notes for our student loans. We all did have access to almost everything in this talk when we signed on the dotted line, but methinks the school discovered that not every incoming med student reads all the fine print on these loans. Alas, I guess it is a necessary evil (perchance I can still wish that I slept late instead of showing up for this 9am talk!) Oh damned fates!

Next was the talk on Outlook/ID getting time. When I skipped out, I went over to the library (the "BIC") and asked the barista there where the ID place is. The baristas have become my unofficial OHSU information people. They helped me find orientation yesterday, too. I have a feeling that they are going to be a valuable resource over my four years.

The next talk is a rarity in orientations. A session that was waaaaay too short. A research librarian came and gave a 1 hour presentation on using the library and conducting research online. Why this was given the same amount of time as the Outlook training is beyond me. I think all of my classmates agree that this could have gone on all day! I am actually considering stopping by on the weekend to see if one of these librarians can help me get oriented further. There were so many cool things that he showed us that can make our lives tremendously easier in med school...and because he had so little time to go in depth, we all have no clue how to really do them. Why do you tease us so, OHSU, why???

A boring but necessary talks on healthcare privacy followed. The speaker did the best he could with it, but the topic is a bit of a snoozer. This presentation is a necessary evil for any healthcare professional today. I think I have been given some version of it 5 times over the past two years. (On a side note, has anyone thought of designed a T-shirt with "Hungry, Hungry HIPAA"? What would the logo look like?)

Finally, before lunch, we all attended a political rally. The OMA (Oregon's state version of the AMA) and the local Portland Metropolitan version of this group came and basically worked to get us all fired up about advocating for our rights and doctor's rights. This event stood in stark contrast to the rest of orientation because of its political, and the call to arms. In particular, the one doctor was very worked up as she detailed the many political issues facing doctors locally and nationally. She was a very entertaining and passionate speaker, and quite fun to watch.

My big question, that is still unanswered, is what is it that doctors want? I feel that there needs to be a clear vision put forth by the profession regarding the healthcare crisis. Right now, all I hear are reactionary criticisms. Why doesn't the AMA hire some consultants to draft their own solution to the crisis and publicize it widely (like the oil companies like to do, for example). I feel that there is a lot of reaction, but little is proactive or preventive. If they did design an alternative, I have heard nothing about it anywhere. I know, I know, I am likely to inexperienced and too naive to really know what is going on, but this is my perception as a former civilian and newly minted medical student. Perceptions have power.

So, anyway, that was the big chunk of the day. The rest of the day was spent in a final lecture about our transformation ("It is not JUST about a transfer of knowledge, but also about our transition into physicians") and then broken into small groups discussing our hopes and "concerns" (read FEARS!!!) Strangely enough, our hopes sounded a lot like fears as well. Guessed we all are starting to realize what we have gotten ourselves into and are a bit freaked out. I guess fear is a good thing.

--CORRECTION--
The email orientation was only 30 minutes, but the library had a full hour. I can no longer remember if his time was cut short at all...but my point still stands that we could have used much more time with him.

The Great Day

So today was the first day of orientation. It was really good. Apparently, I am some sort of mild pre-med celebrity from my regular and frequent posts on the Student Doctor Network which was a bit weird, and unnerving at first.

Anyway, my day was great but really it had nothing to do with orientation. Today Courtney went out and got herself a gig teaching dance in Camas, WA. This was her second interview at this studio and, after watching her dance videos, they bumped up her offer significantly because she is THAT GOOD. I am so happy for her, because I know it has been a bit of a struggle for her at times. But I am especially happy (and relieved!) because, here she is, stuck with me out on the west coast and she went and got herself a gig that seems fantastic within two weeks! That has to be some sort of record. Anyways, she is a superstar and I am extremely happy for her.

My part of the day was good, as I alluded to earlier, but nothing surprising (aside from the unexpected notoriety.) We had talks from a couple of Deans, got some photos taken, and everyone was really, really nice and nobody felt fake. So far, Portland is looking very promising for the Shapley clan.

Orientation Tomorrow!

It is starting. Tomorrow morning, at 9:30 am, I will sit down with my future classmates and enjoy coffee and various pastries. This is the first, official event of my orientation into med school. We will be all pumped up with caffeine and sugar...how appropriate.

I have already had two, less official, events so far. On Saturday night, there was a very nice bbq hosted by three of my classmates who are sharing a house together. Everyone was really nice, and quite interesting to meet. Tonight, the wife and I went to a reception at a second year's house for married students and their SO's (and kids, if they have them...we don't, just the little dog!) This was really great, particularly because we both had a great time and met a few couples that I can see us spending time with over the next few years. It looks like we won't be alone after all!!!

So, as I sit here now, I can feel the anticipation mounting inside of me. I know I should go to bed, but I am getting a bit excited and know I'll have trouble quieting my racing mind. The good thing is that I know that the only thing I have to worry about tomorrow is my appearance. They are taking our id photos, and these photos follow you around for the next four years. I have to make sure I look sharp!

Oregon Photos

Mountainous, desert region of Oregon.

Some industrial operation in the mountainous, desert region.

Cows at the rest stop.

A sampling of bugs from across the country.

Intimidating scenery.

Wildfire!

Wow. (Columbia River Gorge)

Columbia River Gorge

Columbia River Gorge

Columbia River Gorge

Mt. Hood. Visible on a clear day from Portland.

Photos from the drive Across Country

Utah is sadly under-represented, because the camera died as we entered the state (and the Rockies!). Oregon will get its own post.


Rest Stop in Iowa

The World's largest Truck Stop

The cabin in Nebraska

A cropduster in NE (they were everywhere!)

Sunset in NE

Dramatic scenery in Wyoming

Wyoming

A tree growing out of rock in WY

Mountain area in WY

Seems like a postcard (WY)

Falling Rocks, anyone? (in WY)

Drac, we're not in Pennsylvania anymore! (in WY)

The rocks are crazy here (Wy or UT)

Wyoming/Utah

Wyoming/Utah

Utah (rocky mountain area)

Fire hydrant at the "pet rest area" in Idaho

We've been adopted!

So, last night we had our first dinner guests. Ed and Robin are in their mid-sixties and some of the sweetest people we have ever met. I met Ed because I was following signs for a garage sale in a residential neighborhood about 1 mile away from where we live. The actual sale was a bust, but Ed came out of his garage and waved me in to show me some stuff he was trying to get rid of. He ended up selling me a solid wood kitchen table with 4 chairs, a solid wood 5-shelf bookcase, and a 27" TV for $125!

We ended up talking for a long time and the next day, Courtney and I came back to his place to pick up the stuff in a U-Haul. We all hit it off and exchanged numbers and when we talked again Courtney and I decided to invite him and his wife over to be our first guests. We thought it would be a great way to light a fire under us and make sure the house was in order before the madness of medical school started.

So, last night was the night. Of course, I am cooking this big meal for us and the temperature outside is soaring into the triple digits! And, of course, we have no air conditioner and only a little 7" fan from Fred Myers. It was at least 15 degrees hotter in our apartment than outside, to boot. So, Ed and Robin come over and we quickly decide to take all of the food to their place and enjoy it in the central air conditioning. They have a wonderful place, it reminded Courtney and I of our old place in Philly. We had a great time, even though my fish and chicken left something to be desired, and we didn't get home until 5 1/2 hours later! At the end of the night, they both told us as we left that they told their whole family about us and that there are some relatives closer to our age they would like us to meet. They also added that there is plenty of room in their family for us! It was really sweet of them. It is a good feeling to know that there are nice people out here willing to give help you out when you need it.

Last Day of Freedom

Well, it is Friday. This is the last day of my life before my medical school commitments, be they official or unofficial, begin. It is a bit surreal.

I figured I should start this blog now to keep track of my various thoughts, feelings, and experiences during the grueling journey that is ahead. I also am hoping that it will allow me to better keep in contact with many of you we have left (and miss terribly!) on the east coast. I have always been terrible with emails, and I strongly dislike the phone, so hopefully this blog will let you all know that I haven't forgotten about you. Remember, there is a second bedroom available for those who come out and visit!

Well, I figure I should try to briefly sum up the past three weeks for those who haven't heard. So...here it goes.

The Drive
Well, first of all, the dog was fine. He was quiet and well-behaved sitting in his carrier in the car. He only cried when we went too slow...or when Courtney was driving! He was not too happy with our hotel choices. No one liked the room we picked on the first night. Basically, never stay in a Super 8 Motel unless you are drunk or high out of your mind. We stopped in one in Indiana and it ruined the state for us. We never want to go back to that state, or Super 8, ever again.

We took I-80 out, and the first day and a half were uneventful and a bit boring. The only pretty place we saw was Wheeling, WV. We were unimpressed with the PA Turnpike (perhaps we were both a bit de-sensitized to it) and Ohio was equally uninteresting on this route. Indiana was just more of the same.

The real good stuff started when we crossed the Mississippi River. In Iowa, we encountered the most beautiful rest stops (what do you want, this wasn't a tourist excursion!) They also had the "World's Largest Truck Stop", which we stopped at. It was like a huge gift shop and a giant truck store rolled into one. You could buy as much chrome as your heart desired.

Nebraska was next. Most of Iowa and Nebraska felt the same. Lots of corn fields. We stayed over in Nebraska and it was our best night. We had a small, private cabin by a manmade lake. This was some sort of wild west resort town and I think you could do cowboy training here if you are a "city slicker." Drac found a frog on our morning walk and didn't know what to do with it. The room itself was really nice (flat screen tv, private refrigerator, all new everything) but the people in the neighboring cabins looked very odd. Courtney was afraid they were going to break into the cabin in the middle of the night and kill us. Well, I guess you can't have everything perfect.

Now, two-thirds into Nebraska, things got interesting. Here is where it really started to look like the wild west and I believe we encountered our first, small mountains. The cross winds also started to pick up, which made driving with our rooftop box (with a speed limit of 75 mph!) quite a challenge. This part of Nebraska transitioned nicely into Wyoming, which is the real wild west.

Wyoming is the least populated state in the country. There are more cattle than people, by far. The ground is dry. There are huge ranches, tumbleweed, mountains, cowboys (they drive pick-up trucks now, apparently) and wind farms. We had to make our only repair in Wyoming. The rooftop box started to come open a bit, so I had to duct tape the seam and also tie the top down to make sure it didn't fly open and send our belongings all over the Interstate. You will be glad to know that this was a success and we did not send toilet paper and hangers all over I-80.

Utah was next, and the prettiest. We were only there for about an hour. Of course, the digital camera ran out of charge here, so we only have a few photos of the rockies as we passed through. They were just gorgeous! Courtney has now decided that Utah is at the top of the list for potential residency spots. I guess we should be learning how to ski. We also stopped to grab a bite to eat here, and the people were unbelievably nice! We got some chicken sandwiches at a Carls' Jr. and the staff held the door open for me. This would never happen at a McDonald's on the east coast. It is amazing how nice people are out here.

At the end of the day was Idaho. This was a major downer after Utah. We actually couldn't get a hotel room until Boise, because the places 45 minutes outside Boise were all full. It was dark, we were tired, and the roads, really sucked. In the morning we got some breakfast in Boise and the people seemed very odd to us. We were happy to leave.

Finally, on the fourth morning, we made it to Oregon! Surprisingly, Oregon is not all evergreen trees. Our trip actually started with some low lying mountains in a desert! Not at all what we expected, but very beautiful. Also, Oregon outlawed billboards in many locations. As a result, the drive was extra beautiful because there were no ads in the way. After the desert, we went to the top of a mountain covered in evergreens and then proceeded down into a valley where we saw our first wildfire. It was really interesting to see. We then proceeded through the Columbia gorge, which is like a mini-grand canyon. Courtney took a million photos. Occasionally, we would catch a glimpse of Mt. Hood, the dormant volcano about an hour from Portland. What a change of scenery from Philadelphia! Yes, Mt. Hood is a bit more impressive than the liberty bell.

Finally we made it to our home. 12 of the boxes we shipped out were waiting for us at our new apartment and it was already time to get settled in.

Next Two Weeks (Summary)
The next two weeks, which we are at an end at, were somewhat mundane. We spent the time getting used to the area (the food is just amazing!) and getting settled into the apartment (old apartment was much nicer, but this neighborhood is like living on the main line, we do have a deck though.) We eventually got our licenses (Courtney got a much higher score on the driver's test than me :) ) Courtney actually got offered a job today and a really great studio just outside of Portland. She is really excited about it and I am excited for her. We bought a ton of furniture from the Goodwill, Yard Sales and Craigslist.

Well, that is really all I have for now. I'll add more as the school events start. We miss you all and hope you are well!