vaginal prolapse

So this summer, I'll be doing a summer research internship with a physician/research in the urology department of my school. I'm really excited about this internship because I'll be able to see how a real, practicing physician/surgeon also balances research.

His specialty is female urology, in particular vaginal prolapse. His week is half surgery, half research.
This week, I was able to observe some of his surgeries and part of a hysterectomy. I wasn't able to observe the full surgery treating prolapse because part of my job is to take the tissue from the anterior vaginal wall which he removes for the procedure then test the tensile strength of it using this big, fancy Instron machine. I, and the research student before me, aren't really enthusiastic about this study. First, the measurements are pretty crude and very prone to human error and variance between testers. My second task is to help my PI take elasticity measurement of the prolapsed tissue in vivo. This is pretty neat. The one problem, though, is that the machine is so bulky that the elasticity measurement can ONLY be taken for a prolapsed vagina - it's too large to take measurements for normal vaginal tissue. This unfortunately means that he has no control measurements. However, fortunately, there is a new model of machine coming out that is much smaller and thus hopefully will allow for in vivo measurements to be take in a non-prolapsed vagina.

What I really would like to try and start this summer with my PI is to see if there are other ways we can use the vaginal tissues that we collect. For example, are there any biochemical assays we can do (mRNA assays, microchip analyses, etc.). I mean, we have FRESH, HUMAN tissue! There must be something more we can do than just obtaining its tensile strength. We can even use one side of the vaginal wall for physical measurements and then the other side of more biochemical measurements? The problem is, those tests cost money... I don't know what his budget is like.

I worked for a year at a pretty well-established, large laboratory (the PI has been recently elected into the National Academy of Sciences and he will also run a major research administrative position at the university). This lab... had a lot of money. I could basically order kits and procedures that costs in the hundreds of dollars.. even thousands.. range, and it was completely acceptable. So I guess in a way, I'm fairly spoiled in terms of freedom to pursue any random research interest. BUT, let me tell you, my work with him did open another field for him to pursue... a phenotype he's never seen in his knock-out mice involved weight loss. That's pretty good, right? for a recently undergrad graduate to do in a year. Anyways, enough about myself, more about research.

But yea, those are my aspirations for the summer.
And I'm really glad I'll be able to work with him throughout the year. I hope I can produce good, productive results for both my PI and myself.

SAGE Session: Senior Mentors

We just had the most incredible - absolutely inspirational - college session.

Last week, we interviewed/played with infants, children, and their parents to gain experience on the type of interaction and questions we should ask this age-specific patient group.

This week, we met our senior mentor, Ernest 'Bud' Mantz, a 90-year old man who really is.... a super man. I came out of the session so moved, so inspired, so excited about life and the future. I felt so honored to meet this man, to hear his stories, to receive his life advice...

So Bud, the superman. He has hiked, traveled, kayaked -- any physical activity ever possible -- all over the world. He starts his sentences nonchalantly like, "When I was on my last five miles of the Tour de France..." or "While I was hiking across the Sahara Desert..." He lives his life driven by what he described as a sincere, natural energy and passion to really.. be alive. He doesn't do what he does because it's "good for you" or "healthy" or "recommended" by physicians, philosophers, educators, whatever. Every day he lives, each moment is to fulfill his passions and to do what he loves with the people he loves. He embodies passion, raw energy, and love.

He gave us several pieces of advice which really.. made me teary-eyed.
One is to find the things that we would love to do... and just save the money and time to go do each and every one of them. It doesn't matter what a particular goal is - doesn't have to be some crazy adventure half-way across the world. Whatever draws us in like a natural magnet.
He told us that all of the regrets he has in life is not what he has done but what he has not done. I know we've all heard that before, but it vibrates so differently within when you hear it from this amazing person who truly lived life following that personal mantra.

He talked about how he used to be a hiking guide for this rugged, unmarked terrain somewhere in the US. He told us about this one time, he met this Native American man. During their conversation, the man held intently in front of his face a random piece of nature - a rock or leaf or twig - while gazing directly and deeply into Buds' eyes. Later on, the Native American man, alone in front of his fire, would get out those little amulets? reminders? of the people and places that have marked his memory and would thus no longer be alone. (Bud told us the name of those small trinkets -- but I forgot it at the moment -- managan? something like that.) Bud then told us to have something like that as well. Bud himself keep various notes of all of his important experiences. And, while he was hospitalized after an injury, he was able to look at those notes and be reminded that he is not alone - that his life has been filled with blessings, amazing people, unforgettable memories which are alive and within him each and every day.

AHH... I'm getting a little teary-eyed just thinking back to this afternoon...

I asked him if he has any secrets to a good, long-lasting marriage.
He said that each man and woman has his or her own set of interests and hobbies, but it's nice to be able to share passion and activities and adventures together. When he hiked across the Sahara, his wife followed because she "married him to be with him." However, he also said that spending too much time together can lead to irritation, so it's also nice to spend some time separately. So, for them, after a trip, his wife would go off to some city or country and go explore her own interests. Then, when she returned, "it'll be like honeymoon all over again."

Quick Update

It's been a while since my last post. Medical school is getting busier and more hectic.

We're currently in our physiology and cell biology block.
We finished our first CB test and just finished our 2nd physiology test (pulmonary and GI).
The tests were supposed to be on Fridays, 1 week apart (which means about 2 weeks of intense studying). However, due to the crazy weather, school was canceled for 4 days, resulting in the test being postponed to the next Wednesday. Let me tell you... that was hard on everyone's energy and drive. We were all ready to celebrate the end of 2 weeks of studying, enjoy the nice weekend. But instead, we were stuck indoors in the snow and ice. I definitely struggled to open my syllabus again.

However, that's what friends and colleagues are for. We were able to help each other keep up the study spirit, making sure we go through the entire syllabus yet again before the test on Wednesday.
I actually ended up scoring really well this last physio test - perhaps the extra time and extra help from friends was beneficial.

Today, we are having our first FULL physical exam practice with a standardized patient. 25 minutes. Video-taped. We are all not prepared... but hopefully, 25 minutes will go by quickly, and I'll be able to do the basic things that I know how to do (vitals, head/face/neck, cardiovascular and pulmonary...) I'm not as good with the abdomen, musculoskeletal, and nerve reflexes. But we have to learn and practice at some point.
They're really throwing us into this. But I guess that's just how things are. Everything has a start - sometimes it's an ease-in kind of thing, sometimes it's a blind-dive.

I wonder when we will begin transforming into the naive, immature students that we are to mature, professional physicians.

Standardized Patient: Abdominal Pain

For our second standardized patient interview, we were given a patient with complaints of abdominal pain.
However, the secondary task was to incorporate 4 techniques:

1) Following a Patient's Lead
So, if the patient is describing their chief complaint and mentions something on the side (ex: I should have come in earlier.... Since my mother passed away... I needed a way to wind down)

2) Redirection
If a patient begins to ramble on and on, end it with a comment of empathy and continue seeking further, medically pertinent information. (ex: This must be a rough time for you, and I would like to help in the way that I can. So, can you tell me more about the stomach pain you've been experiencing...)

3) Clarification
Patients can be vague. They can just say, it hurts. So clarify.

4) Sensitive topics
Drugs, Alcohol, Depression, Sexual issues --- never show judgment ever. We can use the "Sometimes" techniques. (ex: Sometimes, when people feel really low, they just feel like giving up. Have you ever felt this way?)


I had hoped that I would get a female patient this time, so I can practice asking questions about reproductive issues (especially with abdominal pain, since ectopic pregnancy could be a possibility). However, I actually interviewed the exact same patient as my first time. An older gentleman... but he's nice but gives good constructive criticism, so it's alright.

My patient had pain, which I had to clarify as abdominal, and he mentioned that drinking makes it better. Ding Ding. Drinking problem. So I expanded on that.
But I think I did a pretty good job at the non-judgment part - I treated his "drinking half a bottle of vodka a day for the pain" as "taking an advil whenever the pain occured."
What I need to improve on is saying Um and Er less!!
Also, I need to make sure and ask everything in the patient history template. I often forget to ask about social support.. or I'll ask about recreational drugs but not smoking, etc.

These standardized patient interviews are a good way to practice and can be kind of fun.
We've now received a USB that will save the video of every interview we do for these next 2 years. I hope to see a lot of improvement from now until end of MS1

End of Anatomy Block

Today, we had our anatomy lecture final, concluding the anatomy block of medical school year one!
I thought about this for a while, but I won't be holding and observing the body's internal organs for a long time... maybe never... definitely never for those students not interested in surgery of any type. From now until the third year when clinical rotations begin, we'll be studying from books and lectures, with the occasional patient interview and clinical skills lessons (giving physical exams, taking blood pressure, phlebotomy next year...).

Now that anatomy (and the stress of the exams) is over, I'm beginning to miss it already and am developing an even greater appreciation for this course.

Really and truly, I don't think I would have been able to learn half as much if we had learned anatomy by lectures and anatomy atlases alone. First, how do you truly visualize depth perception? Orientation of all the organs and blood vessels? When I think about anatomy, I actually think about the dissections I've done, where I saw the structures, to what they were connected, and their general orientation. Also, Netter's Atlas may show the typical body, but there is a lot of subtle variation that I think is important to understand.
And then, there is nothing like holding a heart in your hard, looking at it from all angles, and connecting what we see with the functions we've learned through lecture. Now that's real integration.

This week, our class is holding a vigil for our donors and their families. My tank mates are to write a note of some sort to "Gertrude," to be cremated with her, and hopefully we'll also write a letter of gratitude to her surviving loved ones. It must have taken great courage for them to allow the body of a loved one to be used for our learning. Because we've learned a lot from her. Head to sole of the foot, we've dissected and looked into ever space and crevice.

Hopefully what I've learned these past few months will stay with me for a lifetime.

Waimea Canyon - Kauai, Hawaii

snipers vs. gunners

We all know what gunners are (and who the gunners are in any given class).
Urban Dictionary defines them as: "A person who is competitive,overly-ambitious and substantially exceeds minimum requirements. A gunner will compromise his/her peer relationships and/or reputation among peers in order to obtain recognition and praise from his/her superiors."

Not that I have anything against gunners. They are smart, do well in school, and I know that even my father who I respect enormously was a gunner in his student years. So, for all the gunners out there, carry on.

Those I do NOT appreciate, though, are the snipers.
There isn't an entry for snipers, yet, but it's growing in popularity as the word to describe those students who act really cool, nonchalant, and act as if they spend little to no time on their studies outside of the school or classroom.... but no.... at home, they're going at that textbooks and paper stacks like crazy. What is their motive? Do they want to seem like they're smart without even having to try? Are they trying to influence others to "also not study" and actually take on the attitude of aloofness so that the grade curve will be better? Or maybe they just don't want to openly stress out like everyone else? For whatever reason, I just find it a form of dishonesty and deceit.
Of course, in the end, we are all adults becoming professionals, so we should study and do our best regardless of what others do. But, I like medical school because my friends and I are like a team, helping each other, encouraging each other, pushing each other, teaching each other, learning from each other....   That kind of bond can't be formed, I don't think, with or among snipers.

So sniper vs. gunners, I'd take a gunner any day.

Toys in Babeland, New York City

Bar Golf!

My medical school friends decided to blow off some steam with a night of... Bar Golf!
The craziness of the twenties can be intoxicating (quite literally).
We're only young once, right?

So here is how the game went.

"Prepare your sweater vests and argyle socks. This Friday, we're going golfing! Well...of sorts.

Starting at 9pm, we are making our way through 9 holes of Bar Golf along McKinney Ave. If you're unfamiliar with this particular sporting event, the rules are pretty simple: we walk from bar to bar, and you are rewarded points for the drinks you conquer. Keep track of your points, and the winner with the lowest score has bragging rights for the rest of the season.
---
We will walk the following 9 holes:
Uptown Bar & Grill
Idle Rich Pub
Blackfriar Pub
Gingerman
McKinney Ave Tavern
Rok Republic
Quarter Bar
The Loon
Lemon Bar

Scoring is as follows:
Water = +1
Wine/beer = par
Mixed drinks = -1
Shots = -2

Some places have special scoring rules. At Gingerman, we're playing sips of beer as your strokes. 5 sips is par... above and below that, you get the picture. And at The Loon, because they're known for their atomically strong drinks, a Red Bull & vodka is = -3.

So, in summary, come out in your golfer's best (crazy golf attire is a MUST), and play a sport where hopefully no one gets injured."



It was a pretty fun night. Good friends, a little bit of that competitive flair. 
I won't reveal who won and with how many points below par, haha
We all need a break sometimes from our books and study carrels. : ) 

White Coat Ceremony

The White Coat Ceremony seems to be a new tradition for medical schools, started in the 80s in Columbia Medical School I believe?

Honestly, I don't feel ready or qualified to wear or even own a white coat. We haven't even finished half a year of medical school! A friend of mine put pictures of Halloween and the WCC in the same facebook photo album, titled 'Playing Dress Up.' My feelings exactly... When I got my coat, the arms were a little too long and I really felt like one of those little kids, playing dress up their mothers' shoes and jewelry, slabbering on some lipstick and blush.

But, as my mentor insisted, the White Coat is a symbol of physician-hood critical to the professional physician persona that we have to build. And that building doesn't happen overnight but takes years to develop. And that road has to begin now, even as students. And when we put those white coats on, we have to put on that professional persona and live up to the expectations that society has of a physician.

Am I ready?

End of Blacktober!

End of the so-called Blacktober (Where we have our last Biochem exam, the anatomy practical, and anatomy lecture exam all in one Mon-Mon week).

To be honest, college finals period was much more stressful... but it's sometimes fun to get stressed and anxious about something just so that the after-celebrations are more satisfying. :D

first anatomy practical

We had our first anatomy practical today.
The general style is like this: The professors and TAs set up stations within the two laboratories, displaying good bodies as well as bones, skulls, and radiographs. Each station had maybe 2-3 things to identify. We have 50 seconds per station. Structures can be pinned, wrapped with string, or anything really to identify it well. We may be asked to identify the actual structure or describe what innervates or supplies blood to it. Some questions included: What ganglion does parasympathetic nerves pass through to supply special sensory to THIS organ. Things like that. The entire test took about 2 hours.

I felt prepared, but I definitely still missed quite a few.
Next time, I plan on going down to the anatomy lab more often before the exam to really look at every single structure that may be tested - that kind of dedication and persistence is probably necessary. But also, it's really helpful to just study with a partner. Not only does it keep your motivated, you really help each other. And, if you can identify and explain to someone else, that means you really know it. This probably really applies to most subjects in medical school. We have our lecture exam on Monday, and I plan to spend most of my time at the carrels to ask questions to my colleagues (who i've gotten quite close too... :) )

Tutoring sessions with the TAs are definitely useful. A lot of the TAs are part of the OMFS (oral and maxillofacial surgery) program, which is pretty elite. At our school, you enter the competitive program after 4 years of dental school, and it involved a 6 year mixed program of medical school (years 2, 3,4) with residency. So these TAs are both students and residents as well.

They also make quite a few dollars being TAs. I heard one tutor earned $11,000 during the anatomy course (september-november). The TA that our group uses earns $40 an hour on private tutoring sessions alone. And the thing is, the TAs actually benefit from this because they will really know their anatomy. My TA was saying how he performed a surgery in the occipital region of the head, and what he teaches us really comes in handy. One word: Baller.

I can't wait until I work with a real body (or a fresher cadaver...)

Ratatat Concert - Palladium Ballroom. 28Sept2010

Done with Biochemistry

We just had our last Biochemistry exam, ending the biochemistry section of MS1. Of course, the topics we learned about in this course will keeping coming at us over and over again. Especially the biochemistry behind cancer and cardiovascular disease (obesity-related, atherosclerosis...) will become particular relevant to future physicians especially in the United States. I hope I can retain as much as possible.

This week is still part of "Blacktober," though, so no celebrating yet. At my school, October is a busy month for MS1s. We had our last biochemistry exam yesterday, followed by our anatomy practical on Friday and then our anatomy lecture exam (which should be a killer) the next Monday.
But, especially for me, anatomy is something I want to learn and get down pat, especially if I'm remotely interested in going into surgery.

I am, however, looking forward to post-blacktober celebrations starting Monday... I'm guessing my college will be having a few celebrations. That's one thing I really love about the college system (the University divides the medical school students into "colleges" to ensure a proper social support network). Our study carrels are actually pretty lively, and while other colleges don't really use it, ours does. Some boys even set up a halo gaming system using the big projector screens -- on both sides of the room!! I'll probably write more about the college system later.

For now, must.. study.
Definitely did not pass the mock practical held yesterday. Whoops.

Okayama roll-cake (岡山ロールケーキ）with mochi (キビ団子), peaches (白桃), honey

first in-patient visit

53 year old man who came to the ER one day ago complaining of a sharp pain on his right side which radiated to his back, worsened when lying down, and was exacerbated by deep respiration. He had clear stomach distention. He expressed a history of alcoholic consumption and has also suffered from bilateral lower extremity edema.
Upon removal of 5L of fluid from his abdomen, he showed clear signs of improvement and the pain has been alleviated.

This was essentially how I presented my first in-patient to my mentor (as practice.. after she and other repeated it a few times). We had to have a Spanish interpreter with us, which was quite a new experience, but I think I had some pretty good practice. I'll be having to do a lot of presenting like this once I start rotations at the hospital.

Later, we went and looked up his chart and found that this gentleman most like has hepatitis C. The doctors are repeating the test to confirm before telling him the news. My mentor says that most likely, looking at his past and current state of health as well as SES, he only has a few months to hit. That reality hit me pretty hard.

I am really glad that medical school weaves in real patient interactions like these. I think it really reminds us what we are in medical school for. Not to make good grades. Not to learn how to pass a pass/fail course with good efficiency. Not to aim for top x% to make it into a certain residency program. We are here to learn how to treat, cure, and save lives. We are here to learn how to heal.
I have to admit that I forget this little detail all the time and get focused on other aspects of medical school. But that's why I really appreciate this 2 hour session with our mentors every week - brings the larger picture back into perspective.

Eric Morton Wang. ~in memory~

How to Date a Med Student

Friday, November 14, 2008
Marissa Kristal

reblogged from foxnews

Dating a med student? Check out these tips for a "healthy" relationship.
1. Don't expect to see them. Ever.
2. Accept the fact they will have many affairs. With their books.
3. Learn to hide your “ew, gross” reactions when they tell you all the stuff you never wanted to know about your bodily functions.
4. Support them when they come home after each test, upset because they failed—and gently remind them after they get their well above passing grade how unnecessary the “I’m going to fail out of medical school and never become an MD” dramatics are.
5. Each week they will have a new illness. Some will be extremely rare, others will be more mundane. Doesn’t matter. They will be certain they have it (no second opinions necessary.) Med school can, and will, turn even the sanest into a hypochondriac. Date them for long enough, and you’ll become one too.

6. There will be weeks you'll forget you even have a boyfriend—friends will ask how he is and you'll say, “What? Who? Oh....right. He's well...I think.”
7. They'll make you hyper-aware that germs are everywhere and on everything. Even though you used to walk into your home with your shoes on, and sit on your bed in the same clothes you just wore while riding the subway, or sat on a public bench in, you'll become far too disgusted to ever do it again. Believe me, it's going to get bad...you'll watch yourself transform into the anal retentive person you swore you'd never become. And when you witness others perform these same acts that, before you began dating your med student, you spent your entire life doing too, you'll wince and wonder, “Ew! How can they do that? Don't they know how many germs and bacteria they're spreading??!”
8. Romantic date = Chinese take-out in front of the TV on their 10 minute study break.
9. A vacation together consists of a trip down the street to Walgreens for new highlighters and printer paper.
10. Their study habits will make you feel like a complete slacker. For them, hitting the books 8-to-10 hours a day is not uncommon, nor difficult. You'll wonder how you ever managed to pass school on your meager one hour of studying per night.
11. They're expected to know everything. Everything! The name of the 8 billion-lettered, German sounding cell that lives in the depths of your inner ear, the technical term for the “no one's ever heard of this disease” disease that exists only on one foot of the Southern tip of the African continent. But ask them if your knee is swollen, or what you should do to tame your mucous-filled cough, or why the heck your head feels like someone's been drilling through it for oil for two weeks straight, and they won't have a clue.
12. “My brain's filled with so much information, I can't be expected to remember THAT!" will be the standard excuse for forgetting anniversaries, birthdays, and, if you get this far, probably the birth of your first-born.
13. You'll need friends with unending patience who pretend never to get sick of listening to your endless venting and complaints. Or, you'll need to pay a therapist who will pretend never to get sick of listening to your endless venting and complaints.

But take this all with a grain of salt. It's not like I'm speaking from experience or anything...


 ------------------------------

Granted, this is Fox News, but maybe this will become true in later years of medschool...  
As of now, I don't know enough to be rattling off about obscure diseases but
Some things I might add are
14. Give him massages while vocally explaining what structures of the body are located in a particular area)
15. Bring home fun toys like stethoscopes and the impossible to pronounce but oh so basic sphygmomanometer. And then play doctor!
16. Come home smelling like formaldehyde


And right now, with this pass/fail system... my boyfriend is my fun escape who keeps me sane and happy. He's still pretty central to my life-beyond-medschool. We cook, drink, go to dinners, watch movies together...  Although I often do come home late during the weekdays, we catch each other up on the day's events when I get back - even if it's 1 or 2 in the morning.
But I'm guessing these blissful times will start changing. My busyness will increase exponentially. BUT, we're all busy, not just students and doctors. Relationships take effort and time. And effort is something to be made, and time is something to be created. That's what this still idealistic and hopeful romantic MS1 student has to say.

Chocolate Turtle Fondue, Melting Pot - Addison, TX. (Celebrating 13 months)

Her brain

Now this was pretty awesome.
On Monday we dissected out the brain and identified various cranial arteries, nerves, and non-brain structures. The skull had already been sawed for us, exposing the brain. We essentially have to snip some nerves, cut the brain-stem, and roll the brain out. When do people ever get to the roll the brain out?
We all took turns holding the brain -- absolutely crazy. So much of what makes humans human - unique in our complex thoughts, advanced creations, and metaphysical pondering - is in that brain! In my hands! With just a lesion there or a cut there, you can completely change the personality and identity of an individual!


And we found the masticles.

Let me share the story of the masticles (which isn't an anatomical part).
While we were dissecting the face, we kept getting confused with the masseter muscle and the zygomaticus. One guy at my team slipped up and said "masticles." We laughed because of the sound of it... and we all wondered if there is a body part called masticles. Must be. Sounds like such an anatomical name.

And so, when we rolled out the brain, the guy yelled: "hey i found the masticles!" *roar of laughter*
He was absolutely right. The cerebellum looks awfully like some testicles.
Isn't it amazing how goofy and immature med school students can be.... :D

Elephant Orphanage - Nairobi, Kenya

アメリカの医学部への道

This is a (heavily peer-edited) Japanese essay I wrote earlier this year.

やっと来ました。８ヶ月の間不安と緊張と希望とが入り交じり、びくびくしながら待っていた返事。全米各地の医学部８校に受験したのは大学卒業後の２００９年の夏。全国統計 によると、１０人が複数の医学部を受験した場合、約４名しか入学する事ができません。実際に私がいたプリンストン大学では、医学部志望者の~９４％はどこかの医学部に入学する事ができるのですが、アイビーリーグの大学を出たからといって安心してはいられません。そんなことを８ヶ月いろいろと悩みながら、今年の２月にやっと来ました：第１志望校からの合格通知。

日本とアメリカの医学部進学で一番違うところは、日本では高校卒業後に６年間の医学部に進むことに対して、アメリカでは４年制の大学を卒業してからさらに４年間の医学部に行くところです。つまり大学の卒業証がないかぎり医学部には行けません。また大学卒業後すぐに医学部に行く人もいれば、何年か働いたり医学の知識を深めてから医学部に受験する人もいます。

私の場合は、基礎生物医学関係の研究経験が足りなかった為、医学部を受験する前に第一志望の医学部の基礎研究室で、１年間技術員として働きました。もう一つ大きな違いは、医学部は大学受験と同様に何校でも受験することができるということです。 高校３年の時、私は１８校の大学を受験しました。医学部受験は学部受験に比べて費用 (interview guide) がかかるので一般的には５−１０校に出願しますが、人によっては２０校も受験することがあります。ですからすべて失敗に終わる場合や、逆に受験校にすべて合格する場合もあるのです。様々な大学の難易度統計をみれば、自分が合格圏に入っているかどうかはだいたい予想が出来ますが、自分の結果を確実に当てることは不可能です。なぜなら医学部の入試委員会は受験生を個別に評価し、その医学部にとって最も有益と思われる受験生を選ぶからです。つまり、アメリカの医学部は一日の試験結果だけで合格か不合格を決めるのではなく、一人一人の経験,才能、学習能力を評価し医者としての道を与えるのです。

それでも医学部に受かる為にはいくつか要件があります。まず、医学部進学に必須な科目を多く履修しなければなりません。しかし専攻自体は、ひとそれぞれ興味がある、又は得意で良い成績が取れると思われる科を選ぶことができます。学部の時点で医学部進学希望者の半数が理系と文系とに分かれているのも特徴です。しかし、生物学から物理学までの幅広い高度な科学の授業や英文学も取らないといけません。医学部希望者の必須授業は、医学部で将来成功できるかどうかを篩にかけるために、必要以上に授業内容を難しくし、試験を厳しくしているらしいという噂もあります。４年間の平均成績(GPA)は入試査員会にとってとても重要な要素で、大学での成績がほとんどAの範囲でなければまず医学部には受からないといわれています。ですから受験生は大学４年間良い成績を保つ為に死にもの狂いで勉強します。医学部必須科目の授業は医学部をめざす学生の集まりで、激しい競争でした。

大学での成績以外に必要なのは、自分の実力と能力を証明できる教授や課外活動のスーパーバイザーからの推薦状。できれば３−５通の推薦状を頼み、その中の最低２通は大学の教授でないといけません。私の大学では卒論指導者が第一推薦者になることが一般的です。そして公式な条件ではないのですが、課外活動として病院でインターンかボランティアをするのも当たり前です。私は大学の近くにある病院のガン病棟で２年間毎週１時間から３時間ボランティアをしました。医者の世界をもっと知る為に、いろいろ専門の医者の下で彼らの仕事を見学しました。医者が働く場を知らないで医者になりたいと宣言する受験生の言葉はあまり信用されません。

そして最後に、受験生が一番恐れているのが医学部の全国標準入試（MCAT：Medical College Admissions Test). MCATは近年コンピューター化され、約５時間の試験です。内容は４に分かれており、物理化学（７０分）、生物学（７０分）、国語（６０分）、小論文２つ（６０分）となっています。試験では必須科目で得た知識を評価されます。試験結果は３年間有効なので、個人的なスケジュールといつ医学部に受験したいかを考慮しテストを受ける計画を立てないといけません。私は大学３年生の夏に卒論の研究をしながらテスト勉強をし、４年生が始まる秋学期の直前に受けました。結果は残念ながら自分では納得の出来ない点でした。もう一度卒業後に受けることも考えましたが、大学最後の期末試験と卒論でエネルギーを使い果たしてしまって、再び教科書を開く動機と意欲がなく、結局その時点のスコアで受験することにしました。その選択は今から考えてみると大きな間違いでした。医学部入試委員会ははじめにMCATの結果とGPAを考慮します。医学部によってMCATの点、GPA,あるいは二つの複合スコアを見て足切りを行います。

私のGPAは高い方でしたが、MCATの点はそれに見合った成績ではありませんでした。 すべてはあとの祭りですが、もう少し点が良かったならばもっと州外のいろいろな医学部も目指せたと思うし、８ヶ月の長い間やきもきしながら待つ必要もなかっただろうと思います。一旦医者になるという決意をした以上、疲れてやる気がない時も頑張って精一杯努力をしないといけないということを、この苦しい経験を通して学ぶことができました。

これらの受験のための要件は受験生に共通であっても、医学部へ向かう道はひとそれぞれ異なります。大事なことは、入試委員会の審査官が受験者の履歴書を見て、その人が将来医学の世界で成功するというイメージを想像できるかどうかです。医学と医療に対する情熱を持っている事が大切です。それを体得し表現できるようになる為に、学生は早くから臨床研究をしたり発展途上国へ行ってボランティアをします。しかし医学部は、学生の多様性も重視し、医療関係以外の点で一生懸命頑張る学生も評価されます。そして、人生の様々な領域で深い経験をしてきた人、大変な試練を乗り越えられた人も高く評価されます。私の場合医者になる決意をしたのが大学３年の初めの頃で比較的に遅い方でした。それまで私は色々な経験をしたくて、動物園の研究者の元でインターンをしたり、バミューダで海洋生物学を学んだり、大学のアジア文化団体の委員長をしたりしました。多様な私の履歴書の中で大学の四年間ずっと続けた活動もありました。一つ目は大学の霊長類研究所で四年間働いた事。卒業研究も同じ研究室を選び、マントヒヒの行動学を学ぶために、大学４年の冬には大学の援助でケニヤに行く事も出来ました。もう一つは大学のヘルスセンターにあるセクシャルハラスメント被害者の為の学生カウンセラーとして働き、１年その支援団体の学生会長にもなりました。その二つの活動を通して、私は自分の科学と学習に対する熱意と他人の助けになりたいという思いを表したかったのです。

医学部受験者は出願する前に自分の経歴、成績、試験結果を見て、自分が受験に勝ち進んでいけるかどうかを吟味します。受験は医学部入学の１年前から始まります。どうしてこのように長い過程を経るのかというと、入試委員会は受験者の一人一人を吟味し、その中でさらに選りすぐった学生を面接に招待します。面接のための費用は個人負担ですから、旅費だけでもかなりの額になります。何十校も受験する学生や海外からの受験者は、軽く１万ドルを超えてしまいます。面接自体は典型的な質問（何故医者になりたいか、現在の医療制度の問題は何かなど）も聞かれるし、とても独創的で医療に直接関係ない質問も聞かれます（最近読んだ本の感想は、一番親しい友人は誰かなど）。 そして面接のあとに受験生ができることは、辛抱強くただ結果を待つのみなのです。私の場合、今年の２月についに待ちに待った返事がやってきたのです。

医学部進学を決意してから今までの自分の考えと行動を振り返ってみると、最初は医学部に受かる事だけを考えていました。本当の事を言いますと、受かる事だけが最終目的になっていたようにも思います。先が見えない不安の中でやっと返事をもらった時、安心と喜びに溢れた途端、ジワジワと医者の姿の自分を思い浮かべることができました。願っていた人生の次の段階に進められる。つまり、私は将来医者になれる。多くの患者さんそしてその人の大切な家族や友達に安らぎ、癒しと希望を与える事ができる。必死で勉強をして色々な辛い思いや大変な時期を多く乗り越えていかなければならないけれども、人の命を預けられる医者になる為には当然な事。頑張ります。まだ始まってもいない医者への道はうんと長いと思いますが、ドキドキワクワク今年の８月まで待っています。

Related Topics for Future Discussion:
アメリカのメディカルスクールの学費




無関係な写真

(blurry) Meryl Streep as Honorary Graduate, Commencement 2009

Trauma

According to the Global Burden of Disease Report, the leading cause of death for individuals younger than 45 is trauma. Out of the possible injuries, Traumatic Brain Injury (CDC factsheet) is the leading cause across all age groups.

The young are dying of trauma.


Unfortunately, due to the nature of this Cause of Death (often careless mistakes, unforeseeable accidents, etc.), funding for research on better traumatic care is limited. Trauma lacks a clear and definable target of pursuit (like Cancer). Trauma surgeons, however, are eager to learn better how to care for patients rushed into the ER with not even minutes - seconds - to spare before critical decisions must be made. Unfortunately, with insufficient academic work, surgeons must rely on instinct and experience. These are necessary skills for sure, but instinct and experience backed by empirical evidence is even stronger.


I feel that slower, more detailed surgical work is better suited for me, but I also feel that I am very calm and rational in intense circumstances. That has never been tested in a life or death matter, so I can't fully say anything, but that may be a good attribute to have for trauma surgeons.

We will see.

Missing Loved Ones, WTC Memorial - New York City

Her face

We unveiled the cloth covering Gertrude's face today to begin the head dissection.
Again, I wasn't as provoked as I thought I would be. She did seem like a nice, old lady that one would see maybe sitting on the porch, drinking southern lemonade. She didn't have any teeth either. But, her lips were white, tongue discolored and deformed, eyes were glossed over, and her face was flat (perhaps because she had been on her stomach for so long.

I did enjoy the facial dissection - all of the careful cuts and maneuvers we had to do to clean around nerves, veins, and arteries was... fun. I think I'm pretty good at these detailed procedures. I was able to expose and preserve the internal jugular vein and its branches to the facial vein and retromandibular vein. I was able to find the common carotid artery and its branches into external and internal. And, with the help of David (TA), I was able to clear out most of the branches of the external carotid artery. What's cooler, I was able to take the facial artery from its branch-point from the external corotid and trace is up through the submandibular duct, across the mandibles, and into the cheek. It unfortunately got severed and my other tank mates started peeling away the facial skin. I'm pretty proud of that handiwork.

I'm also beginning to be able to immediately recognize a vein versus artery versus nerve. Small nerves and arteries are still a little tricky.

And here is a good mnemonic for branches of the external carotid artery:

SAL FO PMS
S = superior thyroid artery
A = ascending pharyngeal artery
L = lingual artery
F = facial artery
O = occipital artery
P = posterior auricular artery
M = maxillary artery
S = superior temporal artery



this post was more of an anatomy self-review than a reflection...
I do have a lot more acronyms for anatomy (many of them dirty for bigger mental impact).
I'll post those up later

View of Paris from Pompidou, May 2009

Science Watch Ranking

September/October 2010 (ISSN 1047-8043)
Rankings for Top Ten Universities In Biological Science Fields, 2005-2009
Criteria: Published Papers

(c) Science Watch Rankings

pass/fail

I got my results for the second biochemistry exam, which was this Monday. Again, I was just a little bit above average but nothing stellar. My scores did improve slightly - so perhaps not attending lecture and just studying/listening to the lectures online when I am most awake is a better way of learning for me. But still not good enough. Maybe it's a bit ambitious or arrogant, but I would like to be at least 1 SD above the mean.

Now, I know that many people will think:  Welcome to medical school! You are now surrounded by classmates who were all top 10-20% of undergraduate - and all 230 of you can't be in the 1st quintile.

Well, as of now, I don't know whether my grades are because I'm not pushing myself or because medical school is just that hard. And, of course I want to be as high as I can be in terms of rank. Call me a grade whore or a nerdy Asian, but let's face it - Residency programs care a whole lot about rank. At a surgeon-interest group meeting I attended, the chairman of general surgery said quite bluntly, the first two things that will open or close a residency program for you will be your rank and your USMLE scores (and also how these factors may significantly affect your salary -- say, $300K vs $600K). So, for better or for worse, I have to take grades seriously.

Here's my problem and my blessing: the double-edged sword of the Pass/Fail system.

Pro: eases you into medical school, allows experimentation with different learning techniques, and gives you time to secure a social base. and I'm relaxed and stress is minimal.
Con: I'm relaxed and stress is minimal

My main problem is that I find it hard to motivate myself and push myself to the max. In the back of my mind, a voice is telling me - it's Pass/Fail! You're passing! Relax! Make some friends! Enjoy the night-life! Enjoy your hobbies! Spend time with family and boyfriend while you actually have the stress-free leisure to do so. And I really have been listening to that voice, having lots of fun and being really laid back and relaxed. But, I also haven't been doing as well as I want to on tests (go figure). Don't get me wrong, I'm not hitting myself over my head for my passing grades, and I don't regret the fun memories and beginnings of friendships that I've made these first few weeks of medical school.

What I worry is that as of now, I don't know if I can reach the intensity that I had in undergrad. I don't know if I have that edge anymore. It's been over a year since I graduated undergrad, and I spent a year at a very social, laid-back lab, working 9-5, going to parties, dinners, bars, movies. I think I forgot that stressful feeling of time slipping through my hands. I stroll through lectures slides and readings,  continuously getting distracting. I don't even know if I can push myself to my personal limit anymore.
This is worrisome for two reasons:
1) substandard grades, of course
2) if I want time to spend time being a normal person, I need to study with higher yield, which means more intensity, more efficiency.

Now, I'm probably being a bit over-dramatic and exaggerating the situation. Come numerical grades, and I'll probably (I hope...) be back to my study-freak, work crazy hard/play hard self in no time. I just hope that the time I get that kick won't be too late.


I think what I need right now is that reassurance that I can push myself again and produce my personal best results. I need to know that I have the mental discipline to reach my maximum effort.

So for this next biochem test next Friday, I'll lock myself up in the study prisons from morning until late-night like I used to during finals period of college. And, we'll see how I do.

The Salt Lick - Austin, TX.  Featured on FN's Best Thing I Ever Ate. Bobby Flay, BBQ ribs

first standardized patient interview!

Was today.

It was actually so much fun, and I am now even more excited about my future career!
I had an older gentleman who came in complaining of constant fainting spells. Important points to hone in were frequency, duration, activities leading up, side symptoms (chest pain, heart palpitations, stress, changes in lifestyle/diet, etc.), and relevant medical history. Other important points were affecting and associated factors, medication, alcohol and/or recreational drug use. Some things the patient later said I should ask more were social factors - does he have a good support system? How does the fainting affect his lifestyle?

But I was told I made good eye contact, made smooth transitions between the questions, showed empathy, allowed him to ask questions and state concerns. His actual comments were: "I liked your direct and caring manner, very engaging and this made me feel confident in you as a doctor. I felt that you asked good follow up questions and gave a good summary."
All of these things may seem so common-commonsensical (I know I did while I was reviewing the lecture on patient interviews). But first time in a real clinical setting with a patient (doesn't matter that he's an actor) really made me nervous! I almost forgot what to do after I shook hands with him.  But after talking to him, hearing his story, I almost forgot that this was a training setting and all I wanted to do was take his concerns away. Make him feel reassured that we will take care of him.

I know some students here don't enjoy patient interaction and want to go into pathology or anesthesiology, but this is something for which I really felt a calling. And I am glad I enjoyed it so much because I really think an excellent physician not only has technique and skill (which can be taught...) but has the patient-oriented drive and motivation. I also would like to be the physician or surgeon that has the right instincts and can be creative. think outside the box. Those attributes, I have no idea whether I have yet or not, but what I need first and foremost is a solid background and knowledge.

So back to biochemistry studying!

Summer in Japan: Red Lanterns and Fuurins (ふうりん・glass wind chimes)