I am an awful person

Nov 12, 2006 19:41

 Terrible.  Awful.  Scum-of-the-earth type.  Just crummy.

Why you may ask?  You might remember me as a good, cheerful, happy
 person who occasionally tells jokes that are actually funny and is
 fully awake for an entire day at a time.  But your memory serves you
 wrong!

I am bad, as I have been ...gently... reminded by several of you,
 because I have been silent.  I left you all in suspense weeks ago--in
 fact what feels like YEARS, or at least months, ago--back at the end
 of "Block 2" anatomy with the internal organs and what not.  In the 6
 or 7 week interim that I fell off the earth and lost my email voice
 (thus becoming bad), I've finished anatomy and resurfaced for air and
 occasional sleep, and this last weekend, guilt-free recreation!  So
 the e-mails begin again and hopefully won't cease when I get stressed
 out this time.  (Part of the problem is finding the time and energy to
 brain dump all this poorly constructed prose, and Fridays after
 preceptorship were definitely NOT it.  I'll figure it out, though)

So let's rewind back to my naive, innocent 5th week of school and then
 fast forward through what's happened since then.  (I'm SO glad that
 all of the "anatomy" parts of this are quickly becoming distant
 memory. Yeay for being done with anatomy.)

After we took our block 2 exam covering the internal organs and
 genito-urinary organs.  Yet again, I got an "Honors" (read "A") grade
 on the test.  It was DEFINITELY harder than the other exam, though! 
 It set my boots shaking.  In fact, I considered writing an email the
 Monday after the exam but I was so worried I wouldn't have an Honors
 to report that I didn't.  *Sheepish look*.  We them moved on to 'Block
 3,' which covered the legs and feet.  This was a very hard block for
 my lab mates and me.  As I might have said before, our cadaver was
 pretty chubby, so there was a lot of fat cleaning to do.  And I had no
 idea how many structures are in the back of the knee (the "popliteal
 fossa") that are totally obscured by chubby tissue.  To complicate
 matters, our cadaver was poorly preserved (he didn't have good
 circulation, it sounds like), so the feet were mummified and we could
 only dissect a 2"x3" patch on the bottom of one foot.  Nonetheless, my
 lab mate Angela perservered in her foot dissection and did a beautiful
 job, earning our table an extra 1% extra credit on our exams!  (On
 which I also got an "Honors", but it was not as high a grade as I
 would have expected.  Again, I felt sheeping reporting anything less
 than 98% to y'all.  Something about high expectations.)  The leg was a
 lot like the arm, and therefore not all that interesting to me.. In
 fact, I pretty much despised working on the leg--it was very messy,
 very frustrating, and not as rewarding as, say, looking at the inside
 of the kidney or carefully dissecting out all of the vasa rectae
 (read: very small blood vessels feeing the intestine.  It was like
 slicing apart saran wrap covering easily-breakable pieces of pencil
 lead  Just imagine it was very wet, fatty saran wrap and it smelled
 unpleasant).

But oh, the last three weeks of anatomy were SOO cool!

SOOOOoOoOO cool!  Omg.  It was awesome.

The last three weeks were spent dissecting the neck, face, and
 head/cranial cavity (we didn't get to dissect the brain, much to my
 dismay).  I'll spare y'all the details, because even I didn't have the
 stomach for it and I've had weeks of in-person desensitization.
 Needless to say, I loved it.  I loved it enough to almost convince
 myself I could enjoy life as an otolaryngologist or some other kind of
 head/ears/nose/throat doctor.  In part, I loved it because there was
 little fat, and no unexpected "hey this cadaver shouldn't have fat
 there" fat.  Mostly, I loved it because everything was beautiful and
 delicate and hard to dissect out.  In the last block, I took a lot of
 pride in, and spent hours, dissecting out the facial nerve, the eye
 socket, my beautiful tensor veli palatini, the pterygopalatine
 ganglion (which is buried in bone, I might add.  I was delicately
 chiselling away using the smallest probes and scissors I could find
 for hourS after lab was over, it paid off--the professor said it's the
 prettiest pterygopalatine ganglion she's seen in over 20 years of
 teaching anatomy.  I nearly glowed myself to death).  I think I
 enjoyed this dissection because you HAD to work hard on it, and there
 was a lot of skill involved, not just fat-shucking.  In other words,
 Melissa hates mindless work and enjoys being challenged--big surprise. 
 There are few moments in anatomy as cool as removing the brain,
 finding the inner ear bones with your hammer and chisel, or tracing a
 nerve from its cranial outlet to its targets.  (Don't worry, there
 were plenty of gross moments to keep me in line and appropriately
 grossed out.)

That being said, the 4th anatomy exam has a reputation for being, far
 and away, the hardest.  There is quite a bit of information covered on
 the written exam, and the practical exam because it covers some 500+
 structures and the space that you're looking at is so small.  Example:
 which do you think is easier to identify, a thigh muscles or a
 ganglion the size of a head of a pin?  So I stressed out, went
 underground, lost sleep, lost sanity, and otherwise freaked out about
 this exam.  And thus I studied really hard--in fact, I studied really
 hard from day 1 of this block.  And what was my pay off?  a 100% on
 the hardest practical of the year!  And 2% extra credit for superb
 dissection!  OH YEAH.  That's how we rock it, Melissa style.  Talk
 about an ego booster.

A sad note from this block, however.  My lab mate Lauren decided to
 take a leave of absence.  As the only woman in our class with an
 infant, she was having a lot of trouble attending school, taking care
 of a frequently sick little boy (who had just started daycare, aka
 germcare), and commuting from Sherwood when her husband worked full
 time.  She left about 3 days into the first week of the head/neck
 dissection, and we all really missed her when we had those "ooh/ahh"
 moments that anatomy students are prone to have between the
 "eww/gross!" moments.  She'll start over next year, and I guess have
 three built-in mentors and textbook suppliers, but it was sad to see
 her go.  Yet another reminder that medical school is difficult to
 manage, and that I should be grateful that I am able to, and at a time
 in my life when it's easy... well.. easier.

So that speeds us up to last Monday.  See, I can be concise-ish.
 Really.  Ok, from now on.  Honest.

So after anatomy, we started "Cell Structure and Function."  Imagine
 rolling histology, cell biology, molecular biology, biochemistry,
 genetics (mmm, genetics), and a bit of physiology all together into
 ONE course.  That's what I'm taking now.  The ranks of 2nd/3rd/4th
 year students were divided about CSF as to whether it was harder or
 easier than gross anatomy.  Some people said that gross anatomy was
 the hardest course they'd ever taken and CSF was a cakewalk in
 comparison (conceptual, non-memorization learners).  Others, well
 most, said that CSF is a major gear-shift and very difficult after
 gross anatomy (probably the rest of us, half memorization, half
 conceptual) and grades drop.  Mom, relax.  Take a deep breath, it's
 O.K.  So far, it's cake-walk.  We've talked about organelles... and
 let me tell you how THANKFUL I was to have a lecture on organelles. 
 After the bulk memorization and redundancy of anatomy, organelles were
 a breath of fresh air.  They felt like what "biology" feels like, like
 I was back on my game and taking classes like I used to in college. 
 Not that I ever took any cell biology classes, mind you--I always
 thought that if it wasn't genetic, or living human, it was boring. 
 But it /feels/ like biology.  It feels good.  Anyway, we've also
 talked about collagen and hematopoeisis (making blood cells etc) and
 leukocytes, and spent 2 hours a day looking at said cells under the
 microscope.  I think I've been so joyous at staring down an un-smelly
 microscope that I've tricked myself into believing that CSF is a
 cake-walk.  I assume it will become progressively more difficult over
 the coming weeks, however.  At least I know that I can manage, grace
 under fire, if without e-mail correspondence, and do just fine in
 class.

I have another test this Wednesday, in my PCM course.  PCM has been
 moving steadily along week by week, covering topics from domestic
 abuse to stress management to heart/lung exam to
 head/eyes/ears/nose/throat
 (HEENT) exam.  Our test on Wednesday is 1/2 written (2 hours) and 1/2
 GOSCE (2 hours).  A GOSCE is a group clinical skills test.  We are
 organized into groups of four to five students and cycled through 6(ish)
 stations where we do mock patient interaction.  So we'll be given a card
 "prompt" that has a patient situation on it like, "Mr. Jones is here for
 a recheck after an acute myocardial infarction 3 months ago.  The doctor
 wants you to give him a complete heart exam and take his recent history
 before he sees the patient."   (although usually with more detail.)  One
 randomly assigned student has to act out the appointment in 7 minutes
 while his/her groupmates and a grader stand by, asking all the
 appropriate questions and demonstrating the physical exam skills we've
 learned this far and explaining their importance so the grader knows we
 understand what we're doing.  Our saving grace is that our groupmates
 can huddle with us for 3 minutes BEFORE the mock exam so make sure we
 know what we're doing, and then there's a 1 minute huddle afterward to
 cover anything missed, and we can get points back for anything we
 mention during that time period.  So if I do a heart exam and forget to
 say, listen to the heart, my group mate can point it out later and we
 still earn credit for that part of the exam.  And Thankee Lord, for the
 *G*OSCE.  If I were solo (in an OSCE) I would be shaking in my boots and
 terrified now.  Fortunately, my group is pretty darn competent and we've
 been practicing all weekend and this evening and we've got pretty much
 everything down.  Still, a test is a test and a test is stressful :)

I recall writing in one of my email missives that I thought PCM was
 pretty lame, in so many words.  In a way, it still kind of is--there's
 a lot of "wishy washy" information that is awfully long and hard to
 absorb after you've been sitting in lecture or lab for four hours
 already. I've actually come to really appreciate class.  I'm very glad
 that we at OHSU are starting to learn these kinds of skills in our
 first year instead of having to play catch up during our 3rd year when
 clinical rotations start.  Not only are we covering exams, we're also
 learning some important patient interaction skills, like how to work
 with difficult patients (read: psychological problems, non-compliant,
 hostile, etc), and how to deal with awkward situations like domestic
 abuse or substance abuse.  During a mock domestic abuse interview with
 another student the other day, the awkwardness was palpable--just in
 PRETEND patient interaction.  How do I phrase this?  Am I crossing the
 line?  Am I offending the patient? Should I push this topic?  All of
 these questions whirl through our minds and most of us have never
 brought this up with a patient before.  I'm glad we're practicing on
 each other and in groups.  However, this brings me to my lasting
 complaint about PCM.  It's supposed to be a great learning experience
 with practicing these skills--but my PCM small group hasn't been
 practicing!  Our small group leaders chat our sessions away (one more
 than the other) and we end up hearing E.R. stories instead of learning
 how to look in each other's ears.  With the test drawing closer, more
 of us have become vocal about our frustration and asked our leaders if
 we could practice instead of talk, and still we wasted time on
 tangential topics, so we're all pretty peeved right now.  *grumble*

Finally, a quick note about my preceptorship.  It still rocks!  The
 doctor I work for is awesome (he is rising in my esteem to a near Dr
 W-ness) and does go out of his way when he can to teach me clinical
 skills.  By listening to what my friends have described of their
 experiences, I am definitely ahead of the curve in terms of hands-on
 interaction with patients and a nice, understanding, somewhat hip and
 very funny preceptor.  It's family practice, so I haven't scrubbed in
 on a surgery like some of my friends, but it's still pretty cool. 
 I've seen a few biopsies, a circumcision, and done a lot of exams. 
 Even though I'm only in for 1/2 day once a week, I've seen a few
 patients 2 or 3 times, and it's really nice to see faces I recognize
 (even if that means they're back in the doctor's office because of
 presumed health problems).  It reminds me of the satisfaction I got at
 my old job from seeing people frequently and making relationships with
 them.  It's reinforcing in my mind that primary care is a definite,
 likely avenue for my future practice and I feel very comfortable with
 that.  I just don't think I could go into a profession, and be HAPPY,
 not knowing "well what happened to Mrs. Jones" or seeing people
 regularly.  A lot of my peers don't understand that, because some of
 them believe in the glory of medicine, or "just want to cut" and
 participate in acute interventions, whereas I'm happy to watch people
 grow and help them do so over a long period of time.  Still... there's
 that fascination with the head/neck anatomy to consider now... gasp! 
 Melissa?  A specialist? nooooo...

What of life outside school, you ask?  Is there a thing such as this?
 There is, in fact.  I make sure to take time off every weekend and
 relax, read a book if I have one (which I currently don't--any
 suggestions?), go out and play with friends.  I'm trying to organize a
 little "wine/food/catch up/movie" night with some friends every month
 so that we don't lose touch--it's easy to not see people for months at
 a time and not realize it.  My big bro & his wife gave me a movie gift
 certificate card for my bday so I've seen some pretty funny movies
 lately, too :)  Yeay entertainment!Somehow, all the little things I do
 to keep busy on the weekend don't seem to add up to all that much when
 you lay it out on paper, but it sure seems busy.  I could use a night
 off.  What am I forgetting?

Oh yes, my life-consuming passion.  I'm still dancing every week, my
 beloved West Coast Swing can't die in my heart.  I may even be
 improving.  I'm plotting an excursion early next year to a dance
 convention in california, one of the biggest of the year I understand,
 and hopefully that will come to fruition.  I vowed to restart Lindy
 Hop now that I've proven to myself that I can dance AND get Honors in
 school, so I even went out and did Lindy last week.  It was SO much
 fun--and such... ridiculously... good exercise.  My relationship with
 Lindy Hop is "one month on, two months off" (much like my e-mails?) so I
 guess I'm starting an "on month" until I get tired of it again.   THAT's
 where all my non-school time goes...

I'm still dating J, and my beloved boyfriend can't die in my heart,
 either.  He tolerates the whole "no, I can't see you, I'm studying all
 weekend" thing before tests (read: every other weekend) pretty well.
 He's very supportive, and helps me as I need it--either to motivate
 myself to study or to remind me to relax as I need it.  I'm glad I
 have him as another pillar of support.  My family's been great too--my
 mom calls me every couple days to make sure I'm healthy, alive, and
 keeping up; Barb actually made me Halloween cookies to give me sugar
 to study for a test, and they were GREAT!  I had to fight my roommates
 for them, but fortunately there were enough to go around.  My friends
 send me little e-mails to check in (or scold me when I don't check in,
 *cough* Don and Carole), and that reminds me that they care and
 reminds me that even med students need to be social ;)  My point is
 that I'm really lucky to have people who take care of me and keep me
 going.  It's a lot easier to tackle a hard test when you know there
 are people around to catch you if you fall.

Well, hopefully this is enough of an update, if vague and short and
 relatively un-funny (as usual, I'm sure), to keep the e-mail wolves at
 bay.  I promise I've reformed and hope to continue sending out
 updates, if shorter, about how I'm doing at school.  The bottom line
 is: really well.  But it IS hard and requires a lot of studying at
 times.  I definitely don't have the time or the money (stupid loans)
 to do all the things I used to enjoy, or want to, even though I'm in
 class now for half the time that I was at work last year.

Hugs to all, I miss you.

Melissa

email, school

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