I actually got through everything on that list, and then some. I've definitely become a more efficient studier over the past year. I've also become a lot more willing to accept mediocrity, which drastically reduces the need to memorize every single tiny detail. After all, my 75 (knock on wood) will look the exact same as a 100. Oh, pass/fail, how I'll miss you.

Tomorrow is the last study day of first year!! I need to get through:

The insulin section of Hormone Action II
Gastro/Intestinal VI: basic science of absorption/secretion
Gastro/Intestinal VII: GI motility
Endocrine IV: Metabolic Regulation
Endocrine VII: Thyroid
Endocrine VI: Man Parts
Endocrine VIII: Girl Parts
Small Group Session: Adrenal
Small Group Session: Thyroid


In that order. Whatever I don't get to, I don't get to. SO CLOSE TO DONE!!!

toastedkelp's Virology quote post inspired me...to procrastinate a little more. Which isn't the best idea ever, since I still have yet to look at the hepatitis and antiviral lectures for the first time. Oh well! I managed to get a few quotes myself, even though I went to class about three times, total. Dr. Dermody was always good for a few gems.

"We're going to go back to biochemistry. You might need to put a seatbelt on." -Dermody

"There are plenty of great seats down here in the front! Two whole rows! No?? ..Okay." -Dermody

"Ah yes, it decreases entropy! It's like the opposite of children." -Dermody

" 'Cuz if it's not alive, then it's dead."- John S.

"You might know somebody like that. Always confident, always confident... sometimes right." -Dermody

"Bacterial colds: do they exist? (no response from the class) This is a closed-ended question." -Dermody

On viral transmission: "Think about that, people. Fecal...oral. Ewww." -Rotavirus guy

Later: "Vomit-oral! That's even worse!!"

"Cytomegalovirus means BIG OL' CELLS." -Dermody

"This is the paper by Epstein, Achong and Barr describing the virus. And what do we learn from Achong? Do not be the author in the middle." -Dermody

"Honest to God, we've got lymphocytes in us with antibodies to sheep red blood cells. WHO WOULD KNOW THAT??" -Dermody

6:25am: Alarm clock on my nightstand starts going off.

6:35am: Cell phone alarm starts going off.

6:45am: Johanna calls me, and doesn't hang up until I confirm that I am up and getting ready.

7:15am: I leave my apartment.

7:55am: I get to school, later than most of my classmates who were able to wake up a full hour later than I did. Yet another reminder that deciding to live in Bellevue was the single worst decision of my life.

8am-2pm: Got my ass handed to me by the Histo final. Lowlights included trying to remember just what distinguishes the thyroid from the prostate, and realizing that maybe I should have learned what shape insulin crystals are. Highlight- the Van Gogh-vary picture made an appearance.

2pm-4pm: Lunch at Jackson's. Actually the best burger I've had in a long time.

4pm-7pm: Dead to the world on the couch at the apartment formerly known as my second home.

Now I'm back at school, kinda paralyzed in fear at the thought of how screwed I am for Virology.

Me: Doesn't that look like a Van Gogh??
Liz: Yes. If he painted ovaries.

(Micrograph from the extensive collection of C. Pettepher, PhD. Used without permission. Am I in trouble?)

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My studying is going so slowly! I don't know why, but I don't feel any sense of urgency. Finals start Friday, and I have to learn everything that was covered in classes that I didn't even attend. No worries!!

It's been a few days since I've posted anything about anything. That's because I was busy taking part in Second Look Weekend festivities. Now that it's officially over, I have to say, it's a lot more fun the second time around. The first time around was pretty awesome, so that's saying a lot. Where'd all the extra fun come from? Two things. First, I obviously didn't have the stress of making this huge decision hanging over my head. Second, I could skip the Q&A sessions/panel discussions/hospital tours that started at 8am.

Talking to the pre-frosh, VMS 0's, prospies, newbies, invitees --whatever you want to call them-- was a blast. I just hope that I was helpful, and that I was able to convey even one-tenth of my love for this place. Alternately, I hope I was able to convince the future first years that living far away from school is a giant pain in the ass, and not worth the money they'd save in rent. A couple of kids asked me if it's really that bad. My reply was that the day I finish first year will be an insignificant milestone in my life, compared to the day I move out of Bellevue. I'm not exaggerating at all. I've only got one countdown going.

ANYWAY, I met a bunch of really nice people this weekend. I'm eager to see who ends up here in the fall. All the social interaction was draining, but there's no time to recover: it's time to prepare for finals!!

I just had the worst dream EVER. I may never sleep again.

( Under a cut for the faint of heart. )

During my preceptorship today, I learned about heart murmurs! They have an intensity scale that goes from 1 to 6, but they don't get too interesting until Grade 4. That's when the murmur is not only audible, but you can actually feel it as you hold the stethoscope in place. Grade 5 is a murmur that's still audible if you hold your stethoscope at a 45-degree angle, with just the edge touching the patient's chest. A grade 6 heart murmur is still audible when you lift the stethoscope off the chest. Maybe it's just me, but that boggles my mind. There was much debate in the clinic today about whether a murmur was a 6 or only a 5, and I was enlisted to cast the tiebreaking vote. Me. I can barely point to where the heart is, let alone hear a murmur by hovering my stethoscope over the spot. Luckily, it was just a good natured debate, and my ruling had absolutely no impact on any sort of treatment plan.

Also today: finally began actual work on my Emphasis project. Today was observing a meal at a local nursing home, and recording all sorts of data about the levels of assistance residents got. Tomorrow I learn data entry procedures! Woooo!

Last night's sleep schedule: 9:30pm-3:15am, 4:30am-8:30am. I'm going to see if I can't be a little more normal tonight.

No GI clinic today, because my preceptor had to leave town for a family emergency. One of the nurses offered to ask another doctor if I could shadow him instead. I nearly bit off my tongue in my hurry to get out "No no, nonono, that's okay, I'll just come back next week." The other doctors are all super nice, but I couldn't pass up an opportunity to escape and rest my tired brain. Which I did, with a glorious, three-hour-long, dead-to-the-world nap. And then I went grocery shopping on an empty stomach and post-exam emotions. Never a good idea. (For some reason, I felt really old when the kid at the checkout had to call a manager over to sell me my hard lemonade.) Then I watched some baseball, and finished As I Lay Dying, and then I watched 24, which was really good. And that's the story of my day. So the most hellish week EVER is over, and it's all sunshine and rainbows from now until the end of first year... right?

To quote Eli's away message, What's the only thing better than 8am class on a Monday? A 7:30am exam. Even better, they actually expected us to stick around for Histology lecture and lab. Clearly, I did not. Nor did the dozens of other people I saw heading homeward. Of course, I'm not at home right now, because I suck at life and picked the world's stupidest apartment. I thought about going home to chill for a bit between the exam and preceptorship, but the drive out and back would have cancelled out any relaxation I could have done. So here I sit, at somebody else's place... story of my life this year. Even though I know my living situation will be better next year, I'm still super-frustrated at the moment. I want to move, RIGHT NOW.

In the GI clinic a few weeks ago, we saw a baby, only a couple of weeks old, who presented with (that's doctor talk for 'came to the doctor because of') "failure to thrive." When she fed, she hardly got any milk down, and pretty much threw up everything she managed to swallow. The kid was so poorly nourished she couldn't even cry properly. The parents, aunts, grandparents, etc. were beside themselves with worry. They didn't know if it was something they were doing wrong, or if their baby had some horrible digestive condition. The doctor went in, saw the kid, and almost instantly diagnosed severe reflux and oropharyngeal dysphagia. You see, swallowing is a surprisingly complicated process, and it's not uncommon for some babies to take time to get everything coordinated. It's also common for the little sphincter that keeps your stomach contents from going up into your esophagus to take time to fully mature. So the baby left the clinic after a few tests and with a plan to have a feeding tube placed. Just a thin plastic tube, up the nose and into the stomach, bypassing all the troublesome parts.

On Monday, the baby was back in clinic for follow-up. After one month, she was the most adorable, roly-poly, happy baby you could ever imagine. The parents, aunts, grandparents etc. were beside themselves with relief and gratitude. She'll have a couple more months with the tube, while her swallowing reflexes straighten themselves out, and that'll be it. One fat, happy baby, ready to go live life. When we left the room, the doctor turned to me and said, with this genuine sound of awe in his voice, "One tiny plastic tube made all the difference for that family. That never gets old." I could only nod and blink rapidly because of the sudden accumulation of dust in my eyes. So...that was an experience. And now I have an answer to the question in the entry title. For the time being.

Yay, the Micro exam is over! Now I can study for the Physio exam I have in a week, and the Histo quiz I have on Friday! Huzzah!

Goals for today:

Learn all the antibiotics
Put the finishing touches on my answers to the Top 10 questions
Review the unit's first three lectures, which I haven't looked at since we had them
Review the concepts we covered in Topics (strep and TB are important, right?)
Review the question bank
Look at all the clinical vignettes
Review all the toxins/virulence factors
Avoid flying squirrels.



Epidemic typhus...has caused more deaths than all the wars in history. In the U.S. the main reservoir [of R. prowazekii] is flying squirrels. -M&I Lecture 36, "Intracellular Microbes"

The other day I realized that I haven't said a whole lot about my preceptorship in the Peds GI clinic. Yes, it's pimptastic. Each week, the attending gives me a topic to research and "present" to him the following week. In between cases, he asks me questions about anatomy and the GI physio I've learned so far (under his direction, since we haven't covered it in class yet). But it's not a bad thing! There's no pressure. I'm not berated if I get an answer wrong (which is often), and I'm showered with praise when I (occasionally) get something right. Seriously, one week I made the connection between pancreatic insufficiency and fat-soluble vitamin deficiencies, and was told I was ready to be a fellow. Clearly not an exact preview of what life will be like as a third year. However, it has helped me develop my "roundsmanship," as the attendings like to call it.

Best of all, my time in clinic is about the only time I feel like I'm actually a student of medicine. I usually go in with the resident to take the initial history of a new patient. When we come out, the attending is seeing another patient, so the resident tells me about any teaching points she can come up with. Then we present to the attending, and he brings up more teaching points, and asks us questions, and we discuss the case. That's when I see how the Anatomy and Biochem and Micro and Histo and Physio is actually useful in helping sick people get better. That's what I signed up for when I applied to med school. I love it. Love love LOVE it.

In other news, went to the Radiation Oncology interest group meeting today. I'm now almost 100% sure I don't want to go into RadOnc. I wouldn't get to diagnose or go in and patch things up myself! I'd have to take more physics!!! Of course, there's the 200K+ starting salary to consider. And the fact that it's basically a 9-5 with no weekends or in-house call. OH WAIT THERE'S PHYSICS. No thanks!

Every time I experience the slightest bit of eye irritation, I'm convinced that I have a Pseudomonas infection. Thank you, Micro.

So there's some basketball going on. While I'm just as obsessed about it as I've always been, I just haven't had the time to actually obsess. I filled out brackets, we'll see how those go.

Today was Match Day: the fourth years found out where they'll be doing their residencies. It was both very exciting (that'll be me and my classmates in three years!!) and very scary (that'll be me and my classmates in three years???!?!?!?!). The event was held in the med school's big lecture hall, so as each VMS IV's name was called, they walked to the front and opened their envelopes in front of tons of people. There was also a live webcast. I like the idea of making it a big event, but it would suck to get disappointing news in front of everybody. Only a couple of people were visibly upset. I don't know how many ran to the bathroom to cry after it was all over. Hopefully, not too many.

As a first year, I haven't had too much interaction with fourth years, but I've made friends with a few, mostly through Bible study. I'm super-happy for all of them. Pediatrics at CHOP or Mass General, Derm at Vandy...good stuff. It makes me all motivated to go study... just as soon as this game ends.

I'm writing this as I sit in the abandoned, nearly-dead mall near my apartment. My car's being held hostage... I mean inspected and serviced. I had to make sure that she'd be ready for the road trip on Sunday!! Yeah, it's a 9+ hour drive, but I'm looking forward to it. I'm surprising Mom, who has been really stressed lately, with having Momo at the house and all. I think having her baby walk through the door when she least expects it will do her a world of good. I'll even behave while I'm at home: I'll and go to bed when I'm told and wake up when I'm told and accept being treated like I'm not an adult even though I am!! Er. I actually am looking forward to being home, and making my mommy happy. Plus, if it's like Fall Break, the road trip could make the whole thing worth it.

Today was our Physiology midterm. Out of the first thirty questions, I was only confident about nine. Then I went back and reasoned my way into educated guesses on another ten. Then I went back again and reasoned my way into half-educated guesses, based on at least one bit of vaguely-remembered information, for another eight questions. Then I said "Fuck it, the information's not going to appear in my head," and guessed pretty much randomly for the last three. I could tell that everybody around me was doing the same. There was much wailing and gnashing of teeth. The sucky thing is, the material wasn't actually that hard... nothing we've learned so far is. It wasn't even that nitpicky like Anatomy and Histo and Micro tests can be. The questions were all perfectly reasonable, and gettable if I'd spent more than just this one week studying the stuff. But I hadn't, so I wouldn't be surprised at all if it turns out I got below a 60%. I can't even use the "it wasn't taught well" excuse because I was never in class. If I failed, I think they'll make me get a tutor, but I might get one even if I managed to pass. Not to help me understand stuff, but to force me to study more. Lord knows I hate meeting to "talk through" material if I haven't gone over it on my own beforehand.

So the midterm was somewhat depressing, but as soon as we were finishing word got out that the Cadaver Ball DVDs were ready!! That instantly made the whole day better. The video skits have been available on YouTube for a while, but we've had to wait for the live acts. A bunch of us gathered around a computer in the student lounge to watch the first-year band and the stomp/step dance. AMAZING. I just have to ask myself, how can one med school class contain such awesomeness?

And Fiona's ready to pick up, already. It's a good thing these people are fast. I was about to head to Chik-Fil-A for some food. I only just realized that I wouldn't have been able to get the fries (gave up potatoes for Lent). That would've been pretty sad...Chik-Fil-A without waffle fries is like a neuromuscular junction without a nicotinic ACh receptor.

I apologize. That won't happen again.

Some have said that my owning my own set of dry-erase markers is a mark of how sad my life has become. If that's the case, what does the fact that those markers are starting to run out of ink say about my life??

It's possible that some part of the building complex I'm in right now is on fire. To get in, I had to pass a police blockade and seven fire engines with flashing lights, stepping over all their fire hoses as I did so. I also saw smoke and smelled something burning. But I can't let a little conflagration get in the way of my Physio studying.

Back to the books.