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.
Saturday, September 13, 2008
Sunday, September 7, 2008
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.
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.
Monday, September 1, 2008
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.
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.
Tuesday, August 26, 2008
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
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 ParkPhotos 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 wifeSaturday, August 23, 2008
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.
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.
Wednesday, August 20, 2008
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.
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.
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