The Culprit Life

We finished up our last CPS case successfully today and our last microbio small group I might add (thank God).

As much as I hate studying with the computer, it is necessary sometimes. And now I am finding it more necessary than ever because I realized I can make notes for my lectures quicker by copying and pasting instead of writing things by hand. It’s all about being efficient. Less busy work means more time memorizing and med school is all about memorizing.

Study, Study, Study

I went to the new Dali museum this afternoon with the people in the Arts and Humanities scholarly concentration at school. We got a private tour of the new facility including and in depth look at a few of the paintings. Because the museum closes early we didn’t really get a chance to look at anything on our own so I’ll have to come back after I take my boards. It really is a beautiful facility and one I think that is inline with the art of Dali. He was an interesting artist, Dali. I studied his stuff a little bit in a Latin American and Spanish Arts and Humanities course I took as a freshman in undergrad. The tour guide shed light on some of the symbols and memories Dali used to create his own myths with oil on canvas. I found it extremely interesting. How Dali develops paintings is a little bit like how I try to write songs a lot of times, detailed and intentional, somewhat abstract and ambiguous but realistic too.

I found out my year to date grades today, (which is what I was really waiting for) and it turns out I’m still passing everything! You can’t possibly know how happy that makes me.

Each 2nd year medical student is required to view one autopsy by the medical examiner during the year. Today was my turn.

First of all, the place didn’t resemble what you would typically think of as the morgue at all. It is a pretty much brand new facility. The bathrooms are nicer than ones in most restaurants I’ve been to. It’s not cold, dark, and full of mysterious metal doors with dead bodies in black bags behind them. On the contrary. It was a big open space with lots of sinks, white boards, even an LCD screen.

The medical examiner was a laid-back woman from Wisconsin.
The body of our patient/cadaver didn’t even look real to me. It looked like a movie prop. So strange. He was a quadriplegic in his 50s with lots of interesting tattoos. As the medical examiner sliced and diced her way through the body, I noticed how bright the colors were, and my two favorites, red and yellow, mostly. They were much brighter than the cadavers we had in first year and much brighter than the patients I see in surgery every week. Maybe it’s because he is somewhere in between those two, having just died the day before. The medical examiner said I would probably be appalled by the way she cut through the body and I was a little bit. Everything was very practical. A giant Y shaped incision from the shoulders to the groin. Separating the intestines from their mesentery; it really is super long like you read about. Pulling the testicles out through the inside of the pelvis. Extracting every organ and placing them all in a big bowl together. The last was the tongue that had to be grabbed through the neck instead of the mouth. She said that was her least favorite part of the whole thing. Finally, she took the big bowl of organs to another sink/table/cutting board while an assistant took a bone saw to the skull; the brain would be the last to be examined.

And so we went through every organ. The medical examiner weighed them all and then chopped them up like you would a bell pepper. The liver seemed more like a honey baked ham. She used a giant kitchen knife for all of this. She had told us earlier that they got all their tools from K-mart and she wasn’t kidding. Large garden sheers were used to crack the chest and paring knife to cut up sections for slides. She took a little square of each organ and placed them in a little bowl together that would be saved for a year in case there was a reason to go back and check them. I couldn’t help but be reminded of the ancient Egyptians placing people’s organs in ceramic jars and placing them in the tombs for safe passage to the afterlife. Some liquids like bile and blood and even bits of the brain and liver were placed in tubes to be sent to toxicology staff who would be able to extract a plethora of info from them. As she cut, we asked questions about the nature of the business. Concerning suicides, she told us the type varies by region. In this area there were a lot of hangings. Concerning funerals, she said all the organ parts would be placed back in the body after they were finished and it would be sewn up quite nicely to where the family could have an open casket funeral if they wanted. She said this as I was watching the assistant peel back the entire scalp in the other side of the work station and the body was still splayed open like an empty treasure chest. We really didn’t have to touch anything but I decided to poke and prod a little bit. The liver was unusually fatty and soft; we poked our fingers through it. The patient had emphysema and the lungs were full of edema; you could feel the alveoli collapse and see the foam bubble up as you pressed down. The heart was large and fatty but the circulation was surprisingly intact. The kidney’s showed sign of hypertension. The stomach showed inflammation. The bladder was clearly infected and inflamed. This guy had pathology everywhere. Of course the medical examiner is a pathologist so there was the obligatory food reference made. The adrenal glands are like pita bread. Finally, the brain was extracted and we felt that too. It was mushy. Very mushy. It’s called respirator brain apparently. The patient had been in the hospital for a while before dying.
The cause of death? Not completely sure. The medical examiner said she believed perhaps his hypertension led to v-tach which led to some medical jargon I didn’t understand. She said she would have to read through his case file and put everything together before she came to a conclusion.

At the end of the session, I asked the medical examiner how she thought her job has effected her personally. She answered very honestly saying that she is definitely more cynical than she used to be. However, she said she would still respond the same way as anyone else if someone she loved died.

Also of note today, I finished the lyrics for a song that will be on the Year Two EP. It’s the first one I’ve finished so it made me pretty happy. Dark stuff.

Oh and least I forget, I got the results of my last test in today and there was most certainly a miracle involved because I did well (or what I consider well, see passing)on everything except pathology which I did terrible in. Completely reverse of the previous test when pathology was the only thing I did good in. Still, I’ll take it.

Today I once again said hello to my old friend exhaustion. We met somewhere in the course of watching eight lectures today and making notes for three of them. And I’m still behind.

For a nice change of pace, Omar came over for half an hour today and tracked all of his guest vocals for the Year One record. Pretty exciting.

I also received my cheap little Holga camera in the mail that I ordered a few days ago because I had bought 120 film for my dads old SLR instead of 35mm so I figured I might as well have a camera to go along with it. I haven’t had a chance to try it out yet (obviously) but I’m excited about the possibility.

“Do you feel that? Do you feel the hole?”

“Yeah, I feel it. My fingers are actually in the hole.”

And that hole was in the diaphragm of an 82 year old woman with a hiatal hernia. Her abdomen was wide open and my hand came up from below, over her liver and into her thorax. This woman had a lot of things that needed fixing. To start, she had a large lump in her left breast which the surgeon took out and sent to pathology. Then, her entire transverse colon needed to be resected because she a some kind of constricting mass there. But before we could take care of that we discovered the hernia which we wouldn’t have found except the laparoscopic technique wasn’t good enough to visualize everything so the surgeon had to open her up all the way. Needless to say it was a long operation/operations. So long in fact that there was only one other case we could do in the morning. I got to close up both incisions with the staple gun, something that I’ve done quite a bit now and is still fun but I wish I could sew something.

At night, Kevin and I finished the last piece of recording we had to do for the Year One album! Or so we thought. There’s a tempo change in one of the songs that we forgot we had made so there are literally eight chords left that we have to record and then we”ll be done. Besides that, there is just the couple guest vocal tracks I need to get and we can finish mixing everything and have this thing out.

Honestly, I don’t feel like talking about it. The test was very difficult. I think almost all of it was fair but it was on the most difficult edge of fair you can get without crossing into unfair territory. I don’t know how I did exactly but it was bad. Maybe not devastatingly bad but still bad. I guess we’ll see.

In the afternoon I tracked a short guitar part and then me and Valerie walked around my neighborhood and I took some photos with my dad’s old film SLR. It was pretty exciting to finally start using it.

I don’t know how I feel about this test tomorrow. Part of me is confident and part of me feels like I’m gonna fall flat on my face. Probably a combination of both. I just want to pass. I just want to survive. I don’t know what else I could possible study but you can bet I’ll be studying something till late tonight. This block, I asked a lot of my classmates what they thought was important from the material and so I’m hoping that nothing shows up from out of the blue on the test. I’m hoping the combined wisdom of some of the brightest people in my class will hold some weight when it comes to the material tested. And I’m praying God gives me the ability to slow my mind down and really discern the important information from each question the way I am being trained to. Because, after all, tomorrow it may be a question on a test but soon it will be someone’s life I am needing to understand properly. Properly enough to save it.

Tomorrow, it is only myself who needs saving.

Study, Study, Study

This is the third day in a row in which I feel like I’ve done pretty much all I can physically and mentally to learn how to heal people. And it feels great. And exhausting. Like a good exhausting.
I can close my eyes and go to sleep at the end of the day and not feel any (or barely any) guilt. Guilt for a medical student and guilt for everyone else is a little different. Normal people experience guilt when they’ve said a harsh word to a friend or took something that didn’t belong to them or broke someone’s heart. Medical students feel guilty when we take a 45 minute lunch break instead of a 30 minute lunch break. Or when we listen to rock music instead of pathology lectures in the car.

Anyway, that’s all I got today. It feels good to be filled with a sense of purpose as opposed to being crushed by a sense of sacrifice. Maybe it’s just a matter of perspective but it makes a big difference.

Another good day filled with almost nothing except learning how to heal people. And I do feel like I’m learning, slowly but surely. I studied outside for most of the day and I think I got a pretty stellar farmer’s tan from it. It beats studying inside though; I find I’m less distracted.

There are very few days when I can honestly say that I did everything in my power to learn how to save lives. Today was one of them.

Surgery was not bad today. It was somewhat exciting, somewhat routine. The surgeon asked me questions that I knew the answers to about the operations but then he asked some random questions that neither of us knew the answers to like what are all the bones of the hand. I think its fun for him. Anyway, I didn’t feel too bad about not knowing a bunch of random questions. I don’t think he expected me to.

Every once in a while the surgeon will ask me something during an operation that I think he does only to show the other health professionals in the room who aren’t doctors, what a horrible time I’m going through. For instance, today he asked me how much sleep I get and how late I’m up studying and how early I get up for school among other things. Of course I answered him honestly: It changes everyday but I often go to bed around 1:30am and wake up for school around 6:30am if I have class that day. Sometimes he asks me if I saw a sports game or t.v. show or movie that he knows I don’t have time to see. It may not sound like all of this adds up on paper but I really do get the feeling when I’m there that he does this on purpose to reveal how hard med school is. I’m not sure if there’s a further motive like to get the others to have sympathy for me or to establish some kind of bond between our mutual experiences or something though.

The first surgery today was interesting to me. The patient was a mentally retarded lady who had some kind of bowel mass that needed to be removed. When the surgeon opened her up, I noticed that her arteries were so vivid and defined it was like looking at an anatomy textbook. I made a remark to that effect aloud but no one responded. Maybe they’ve seen a lot of this type of thing, maybe they are desensitized to the aesthetics of the human body at this point.
What I saw was beautiful.
I wondered (to myself) if this lady had ever been told by anyone that she was in fact beautiful. I wanted to tell her that she was, even if I was the only one to recognize it.

We had an EBCP conference today on shortness of breath. It was kind of disorganized and just silly the way it was conducted. There was a blank powerpoint and an MD moderator (who really didn’t look like he wanted to be there at all) who questioned our whole class, Socrates style, until we filled in all the differential diagnoses and such that he wanted. Meanwhile, one of the course directors got up and pushed us to answer at what percentage of assurance would we treat someone with ant-coagulates when we suspected a pulmonary embolism. We had no idea. Then he preceded to tell us that it was when we had a “gut-feeling” of 50%. I’m not a doctor yet but “gut-feeling” sure doesn’t sound like Evidence Based Medicine to me. I guess everything was alright though because they brought us chocolates since it was Valentine’s Day but I was kind of hoping to learn some actual medicine in class this morning.

In the afternoon, we started another CPS case having to do with seizures. I think it’s probably the most difficult and involved one yet.

I am super behind in my studying. It’s my fault too. I’m so distracted. I really feel like I could use some medication to keep me focused. I know some other people in the class probably take something for the ADD that they don’t clinically have. I think that’s wrong but at the same time I totally understand being tempted to take something like that. Even when you love what you are studying (an I honestly do) you find your mind wandering if you sit there for hours on end (which I honestly try to do).

I am so behind.

Study, Study, Study

Not much to report today, just a PMIID small group and a whole lotta studying in the library.

We had a pathology lab today that went well. A couple of the teachers even took time out to explain a few things to me personally. That was really nice of them.
I also met with the course director of the class I have my worst grade in today. We went through all the questions I missed and it turns out I just made some mistakes because I didn’t read the questions close enough. Also, because I think “too” clinically and jump to a conclusion about what a patient has instead of looking at the details of the question stem. Anyway, she made me feel a lot better about my position in the class and told me that the shelf exams at the end are curved a little for our benefit. Works for me.

We had a pulmonary didactic and skills session where we went over stuff we have seen literally three or four times already. Not saying I have mastered all of it, but we have gone over it quite a bit. In other news, guitar effects pedals are 100 times more interesting than asthma and emphysema. That was my day.

Oh wait, almost forgot. I went to an awesome emergency medicine lunch time meeting today where a doctor I went with to Bolivia last year spoke. He basically made emergency med look like the most appealing specialty ever. He works, get this, 24 hours a week. No lie. He works two days a week. He spends the rest of his time with his kids and going sky diving and wake boarding. Crazy. He said he almost went into surgery too. The good thing about emergency med is you can work as much or as little as you want. You can even work what’s called “Locum Tenens” which are basically like temp jobs for E.R. docs where you can get paid to fly out to some town, stay in a hotel, and work a couple shifts in a hospital. Super crazy! There’s also a residency program where you do three years of emergency medicine and one year of peds training so you can be an E.R. peds doc. Super crazy awesome!!! Man, I think I found a new 2nd choice specialty. Lifestyle feels more and more important everyday.