Hurricanes and Hormones

Hello, world. It's been sometime since I've updated this blog. It's funny because I've had about 12 different people ask me when I'm going to update this thing. Your wish has been granted.

I was going to put this off until tomorrow since it's past my bed time, but I can't sleep tonight. Well, first of all my big dog Yogi is barking at the neighbors who are hanging out by their deck, but more importantly there is this crazy hurricane spinning around in the Gulf about to ravage Southeast Texas. Normally hurricanes don't affect me since I'm about 1400 miles north of the gulf, but this one is about to hit Houston where I lived for about 3 years. I have some good friends in Houston and I'm kind of worried. For those of you hunkered down in H-town reading this: be safe and I hope to talk to you on the flip-side. For some comedic relief here's a clip of Geraldo Rivera getting rocked:


So you might be wondering how med school is going. I have the perfect analogy for you. Med school is like a hurricane. It moves you around a bit, gives you a breather when the eye passes over, then rocks you again before it leaves. The only difference between a real hurricane and med school: med school doesn't pass over and move inland; instead, it comes back and hits you hard again. Week in and week out. Imagine a hurricane on a pendulum.

Sorry, the political season has got me exaggerating a bit. It's not really like a hurricane, but it's close. Honestly, school is busy. There is a ton of work and reading to stay up on. Just when you think you have a break (Saturdays and Sundays), you quickly realize that there is material you should be covering instead of watching that Browns game, or golfing with your buddy who is still on summer break since he goes to a school on a quarter system (damn you OSU).

Block 2 has been somewhat frustrating due to the nature of the material being covered. Somehow we are supposed to be learning about genetics, but somehow endocrine and reproduction is thrown in there for good measure. At times it's kind of challenging trying to see the rationale in some of the material being thrown at us. How is thyroid function related to the "human blueprint"? I can probably make some hand-waving argument as to why we learn some crazy endocrine during this block, but it's a stretch. Apparently, block 2 is the only block where there is a ton of material kind mixed and jumbled without a clear purpose.

So far of the subjects being covered in this block, embryology has probably been the most frustrating since it requires to most rote memorization. Embryo has been presented to us via lectures and these study guide packets. I think there is enough material presented to us to learn what we need to learn, but it's time consuming to take it all in. Sometimes I feel like I'm trying to memorize the dictionary.

IQs have been pretty solid for the most part. My group is productive and we cover all our objectives. Also, the topics covered so far in IQ involve endocrine which I don't mind. It's becoming apparent that pharmacology is turning out to be one of my favorite parts of med school. Sometimes when I'm going over my case objectives and doing research, I tend to get lost in the mechanisms of action of the drugs and how they work chemically. Someone in my IQ group asked how thyroperoxidase works chemically and I was about to jump up to the board and draw an electron pushing mechanism, but I had to ask myself "is this clinically relevant?" and go on to restrain myself and suggest that the group move on to the other objectives.

Really, that's been the theme of how I've been managing my time so far during the preclinical years. I constantly ask myself two questions: (1) "is this clinically relevant?" and (2) "what's the take home message?". Frankly, I think these are two important questions that med students need to ask themselves when they're studying, especially in open-ended curricula like ours. I'm coming to terms with the fact that I am not going to be solely a scientist, but a clinician interested in advancing medical science. I don't need to know everything. I don't need to memorize everything. Working out in the mornings and reading a good book at night to maintain my sanity is more valuable for my long-term health than memorizing some minutiae from Robbins Pathology, board scores be damned (or so I say that now...)

You may be reading this and thinking "duh" but this is a big deal for me. I definitely suffer from a DSM-IV Axis II disorder: Obsessive Compulsive Personality Disorder. I tend to get somewhat worried and flustered when I feel I should be studying more. Learning to let go of the books and seek a balance in life has been one of my biggest goals for med school, especially as I get older and transition into the next phase of my life. I think so far I've been good at it, but it's tough. Especially when you're around a bunch of smart, motivated individuals and you realize how much more you could learn. The guilt felt when you don't attend a Thursday morning review session, or when you can't make that weekend study session...it's somewhat painful.

Even when you are not studying as much as you could, it's tough to maintain perspective and realize what the "big picture" is. I was reminded of this "big picture" this past weekend when I had my OB-GYN RAMP. RAMP, another acronym, is a glorified shadowing program where first years shadow different physicians. Two weeks ago I went to a hospice to learn more about end-of-life care. This past Wednesday, I had a chance to see the opposite end of the spectrum and spend time on the OB-GYN wards at University Hospitals.

I'm not sure how you all feel, but in-patient settings scare me. Yes, I am scared of hospitals (you might be wonder why I want to be a doctor). As I entered the ward I was given a key-card to get some scrubs to change into. First, I spent about 15 minutes trying to figure out how the damn scrub machine worked. The whole time about 3 different doctors and a couple nurses walked by and giggled. I felt like such a dumbass, and I still do.

So I put on the scrubs and I went to the desk at the center of the ward to find a "house-officer." I'm going to throw this out there: going to the desk in the middle of an in-patient ward is like walking up to a liquor store in the inner city (yes I've been to a liquor store before, but not for Cavasier...but directions). It's kind of scary. Nurses sit around the outside of the desk like gangsters. They kind of just hang out and look tough while you walk by. You ask them where the house officers are and they give you a funny look as if you were lost. Eventually they nod over to a couple docs sitting on the other side of the desk.

The docs for the most part are pretty nice. They're like the store owners. Pretty much accommodating and easy going. And no I am not implying that nurses are mean people. They are actually pretty awesome and serve an integral role in our healthcare system. I just think I have somewhat of an inferiority complex right now.

To make a long story short, I was invited to see a C-section delivery in the wards. I stood against the wall as I saw the delivery take place. Two things: (1) C-section deliveries require a very aggressive approach from the OB-GYN. Imagine cutting a hole in a pregnant woman and yanking a baby out. Literally. (2) Anesthesiology seems more appealing to me than it first did. I was surprised seeing the anesthesiologist comfort and talk to the mother while she is undergoing the delivery. The anesthesiologist doc also spoke with the father trying to reassure him as he was kind of freaking out as the baby was coming out. Furthermore, these guys know their pharm real well. The field definitely seems more appealing than it once did. Still, all that responsibility scares me.

Oh ya, I forgot, a baby was brought into this world. Good times, indeed. It was honestly pretty amazing. But it's funny how the OB-GYN acts when the baby delivered. She kind of yanked the baby out and put him on a back table, then went back to the mother to close up shop. It seemed very "business-like." Frankly, that's how the OR is, and I don't know if I like it. It just seems too technical and formal for my liking. I guess I'll learn more during my rotations.

In closing, I promised to make this blog more interactive. I'm going to pose a series of questions and I want to get your thoughts. With elections coming up, I know there's been a lot of crap being spewed by both sides, but unfortunately there has been very little discussion of what I feel to be the most important issue: healthcare. I understand that we all have different opinions and viewpoints. Furthermore, I don't really care if you're republican, democrat, independent or apolitical. I just want your opinion. First, check out this article, which is a good view of both healthcare plans. Second, respond to the following questions: (1) can private markets be utilized to lower healthcare costs and improve healthcare coverage, or is government intervention necessary? (2) What can politicians do to help contain healthcare costs? (3) What if anything should physicians do to help contain costs?