It is really nice outside today! Sixty-six degrees, sunny, not very windy at all. I had to drive to Walgreens to get some allergy relieving eye drops, and I put the top down, and it was heavenly. Unfortunately, I have to stay inside pretty much until I pass out from exhaustion because tomorrow is our final biochemistry exam. And I am failing biochemistry.
I kind of wish I could argue with someone about my specific case, so I will argue with you. Inarguably, I am doing poorly in only two classes: Anatomy and Biochemistry. For all my other classes, I got my act together, learned how to study, and am passing all of them. Except for Anatomy and Biochemistry. I've spent probably an hour looking over my test grades in both classes, figuring out the bare minimum I would need to get on the remaining exams to pass. And this is where life gets sad, because all my test grades in both classes fall into the C to B range... except for the first two in both classes. If I could retake the first two exams, after learning how to study properly, I probably wouldn't be freaking out so much right now. I'd probably eat dinner outside, enjoy the first truly wonderful day of Spring.
Actually, my above admission isn't entirely correct. For Anatomy, yes, all my grades after the first few were in the C or B range. In Biochemistry, I seemed to do really poorly only for one person's exam. He taught two, noncontinuous, portions of the class. When I averaged my grades based on who was teaching the material, I found that for one professor, my average was around 53%. Should I blame the professor? Probably not, but it's tempting when I present statistical evidence that I couldn't learn from that man.
So now I have to get a 97% tomorrow to pass the course. I've gotten 100% before, when I really needed to. I'm hoping that that will help ease my anxiety. I also know how to study finally, so that should help as well. But there's always a large chance that they're going to ask a question you didn't think would be important, or ask it in a way that is much too confusing. So no matter how well prepared I am going to feel--and I intend to feel really prepared, there's always that chance that I will get a 95% and that won't be good enough.
Meanwhile, in a hypothetical perfect grading system, I've come up with a more idyllic plan to promote learning: If a student should get below a 50% on an exam, something I've done about four to six times over the course of all the tests I've taken here, wouldn't it be better to have the student retake that exam? Or have them complete a take home exam? And then the score could be ameliorated to something, still failing, but more beneficial for the student's psyche, say a 60 or 65%. In this way, wouldn't you kind of be forcing the student to relearn the material? Yes, failing should be punished. We can't have our doctors being daft. But by just giving me a 38% on an exam, I have no motivation to ever relearn that material. Quite the opposite really, because I am now so traumatized by the anatomy of the lower extremity that I care nothing about it.
As much as I disagree that all of this information is important, some of it is, and I won't know which will be important until I'm actually out there, practicing medicine. So wouldn't it be better to have students look at material again, instead of consigning them to spend a nice day freaking out way too much about something that, in the end, might be impossible to actually achieve?
Mar 11, 2012
Mar 8, 2012
Selfish Diabetic
Today when I woke up, I woke up with a headache. I cursed my decision to have chips last night as I was going to sleep. Too much glucose. Not enough insulin. I surveyed my skin and noticed I had developed those annoying lines you get from your bed sheets all over my arms. Peripheral edema. Yes. The hyperosmolarity of my blood would have caused an increased retention of fluid in my renal system. I checked my face in the mirror. Puffiness was present around my eyes, though perhaps that had occurred from not sleeping enough.
Fourteen minutes to class.
The oxidative stress of prolonged hyperglycemia on the body can cause diabetics to feel as though they need to sleep more. I have been taking an unnaturally large amount of Vitamin B throughout my medical school year. I do not know for sure if Vitamin B helps relieve oxidative stress--in fact, it very well might make it worse--but it's one of the things diabetics need to replenish according to Walgreens Pharmacies, so I take Vitamin B. I no longer always require eight hours of sleep, although sometimes...
Eight minutes to class.
Objects are falling into my backpack with little thought. Every day is more or less the same. One binder. One laptop. Always the same, though learning is always a little different. Finding my glucose meter, I decide to test. Sometimes I will be much higher than I think, will not take insulin, and spend the entire morning in the 200s. Glucose is 61?
So then what caused the edema? What caused the headache?
I think about my food intake at dinner as I guzzle some fruit snacks before leaving my apartment. Two minutes to class. What could my renal system have been doing while I slept? What about my endocrine system? What was my body doing that caused me to wake up the way I did? Exhausted? Edematous? But with a high core body temperature and a headache?
I wonder all these things and sometimes feel so close to drawing all the lines together and truly understanding how physiology interplays with biochemistry, then anatomy, and how all of these things affect my life. It is frustrating, but it is exciting--as if someone was carefully guiding me to enlightenment, nirvana, without my knowledge. Understanding why my body does the things it does will make me beyond happy. It will make me a fully realized human being.
This leaves me with a few thoughts: Why are there otherwise healthy people in medical school? And how can the few medical students I have met who confess they are only in this for the money... how can they study at all?
Fourteen minutes to class.
The oxidative stress of prolonged hyperglycemia on the body can cause diabetics to feel as though they need to sleep more. I have been taking an unnaturally large amount of Vitamin B throughout my medical school year. I do not know for sure if Vitamin B helps relieve oxidative stress--in fact, it very well might make it worse--but it's one of the things diabetics need to replenish according to Walgreens Pharmacies, so I take Vitamin B. I no longer always require eight hours of sleep, although sometimes...
Eight minutes to class.
Objects are falling into my backpack with little thought. Every day is more or less the same. One binder. One laptop. Always the same, though learning is always a little different. Finding my glucose meter, I decide to test. Sometimes I will be much higher than I think, will not take insulin, and spend the entire morning in the 200s. Glucose is 61?
So then what caused the edema? What caused the headache?
I think about my food intake at dinner as I guzzle some fruit snacks before leaving my apartment. Two minutes to class. What could my renal system have been doing while I slept? What about my endocrine system? What was my body doing that caused me to wake up the way I did? Exhausted? Edematous? But with a high core body temperature and a headache?
I wonder all these things and sometimes feel so close to drawing all the lines together and truly understanding how physiology interplays with biochemistry, then anatomy, and how all of these things affect my life. It is frustrating, but it is exciting--as if someone was carefully guiding me to enlightenment, nirvana, without my knowledge. Understanding why my body does the things it does will make me beyond happy. It will make me a fully realized human being.
This leaves me with a few thoughts: Why are there otherwise healthy people in medical school? And how can the few medical students I have met who confess they are only in this for the money... how can they study at all?
Mar 7, 2012
Library Tang
I have tentatively begun studying in the library. Several things about it bother me to no end, namely, actually, just one thing: the lighting. But during partly cloudy days, it's not impossible to concentrate in the place. Still, I like to keep the affair as informal as possible, choosing to study not at tables... (or shudder... cubicles), but rather in large, low lying chairs that are almost like loveseats in width. I was minding my own assignments, attentively listening to the absolute silence that is graduate school students studying, when a shuffling of feet, not two, not three, but six, six feet! caught my easy to displace attention.
So there I was, staring at three people I did not know, moving at erratic paces, but all together, in the same general direction, through book shelves and behind desks, and they seemed to me very much like any one of the many species of Tang that move along coral reefs. This simile is only mildly appropriate once you realize that Tang are a part of an even larger subclass of fishes called Surgeonfish. Regardless, I wonder if over time the library will remind me of other wonderful places I have been.
Mar 5, 2012
The Human Model
You can learn a lot from patients.
Sometime last week I went over to the Hospital of Veteran's Affairs to volunteer at a clinic. The clinic is submerged into the homeless shelter at the VA. We were instructed to take patient's histories, a skill we all learned as part of our Essentials of Clinical Reasoning course. I was uncomfortable at first, but it's always surprising how human-like human patients can be.
Regardless, one of the people I saw was a fellow diabetic. While the people running the show scrambled around looking for an appropriate test meter (because I do not know how to use the really fancy ones; OneTouch meter's are always full of extraneous options that I can't work), I got to talk to the patient.
Somehow we got onto the topic of significant others, and the diabetic had some wise words to say about the ills of domestic violence. He said two really touching things. The first was a rather hilarious anecdote about the only time he had hit a girl. It was in high school, and he had slapped his girlfriend, thinking to himself that she was acting like a b*#$!. Well, he had not been counting on being held accountable. Coming home, he was greeted by his seven sisters and his affronted girlfriend. They did more than "explain" why his behavior was out of line.
Second thing: he expounded on why women are ultimately the more important gender. I was fairly impressed, and I keep thinking about what a character that diabetic was. I want to write more about him, or at the very least, write down what he said so I can tell my own kids how to avoid domestic violence in relationships. Honestly, I don't think he learned anything from me. But I ended up learning a lot from him.
Another strike against paternalism. Perhaps the doctor-patient relationship is more like a symbiotic relationship, where both groups are made better through their interaction. Regardless, I feel like I could write a chapter on the character that this patient presented, even if briefly--even if less than twenty-minutes.
This is why I went into medicine.
I want to learn more about the human condition. I can't write about people if I do not understand them, first. Certainly that's not only the reason I am in medical school. But for the part of me that is a writer, that's all the motivation I need.
Sometime last week I went over to the Hospital of Veteran's Affairs to volunteer at a clinic. The clinic is submerged into the homeless shelter at the VA. We were instructed to take patient's histories, a skill we all learned as part of our Essentials of Clinical Reasoning course. I was uncomfortable at first, but it's always surprising how human-like human patients can be.
Regardless, one of the people I saw was a fellow diabetic. While the people running the show scrambled around looking for an appropriate test meter (because I do not know how to use the really fancy ones; OneTouch meter's are always full of extraneous options that I can't work), I got to talk to the patient.
Somehow we got onto the topic of significant others, and the diabetic had some wise words to say about the ills of domestic violence. He said two really touching things. The first was a rather hilarious anecdote about the only time he had hit a girl. It was in high school, and he had slapped his girlfriend, thinking to himself that she was acting like a b*#$!. Well, he had not been counting on being held accountable. Coming home, he was greeted by his seven sisters and his affronted girlfriend. They did more than "explain" why his behavior was out of line.
Second thing: he expounded on why women are ultimately the more important gender. I was fairly impressed, and I keep thinking about what a character that diabetic was. I want to write more about him, or at the very least, write down what he said so I can tell my own kids how to avoid domestic violence in relationships. Honestly, I don't think he learned anything from me. But I ended up learning a lot from him.
Another strike against paternalism. Perhaps the doctor-patient relationship is more like a symbiotic relationship, where both groups are made better through their interaction. Regardless, I feel like I could write a chapter on the character that this patient presented, even if briefly--even if less than twenty-minutes.
This is why I went into medicine.
I want to learn more about the human condition. I can't write about people if I do not understand them, first. Certainly that's not only the reason I am in medical school. But for the part of me that is a writer, that's all the motivation I need.
On Call
So my friend just called me to tell me that her twelve year old roommate has been really sick for an entire day. I got to run a differential! So, patient has had nausea for a day, with intermittent vomiting and diarrhea over the same period. Abdominal pain crampy. Pain is also diffuse and not localized to the RLQ (if it were, suspect appendicitis). Patient is afebrile (almost entirely rules out appendicitis). Most likely diagnosis: considering the age of the patient, most likely cause of pain is gastroenteritis, or stomach flu. Patient is advised to stay hydrated and replace lost electrolytes. It is recommended that patient also go to school tomorrow if she feels any better at all.
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