September 22 – 28, 2014
3 months of medical school already! Exams are in about a month, and I am beginning to feel the heat and trying to get my rear in gear! And, I thought very critically this week about how I could be more efficient with my time and made a major purchase to help get me where I want to be concerning time management and efficiency.
MONDAY: Vitamin D
One of our IQ cases this week had to deal with parathyroid’s regulation of calcium and vitamin D. It is quite exciting to really learn so much information each week, and I feel as though I am doing IQ research a bit more efficiently. Essentially, when the plasma Calcium ion levels are too low, the chief cells of the parathyroid releases parathyroid hormone which acts on the bone (making it release calcium) and the kidney such that less calcium is excreted in the urine. The intestines increase their calcium absorbtion and 25-OH-vitamin D is transformed into 1,24-(OH)2-vitamin (d) a more active form. Phosphate ion concentrations are lowered! This concept confused me until one of my IQ teammates explained the phosphate situation using Le Chatelier’s Principle.
To make bone you need calcium and phosphate (to be simple).
CaPO4 (unbalanced, forgive me) <—-> Ca2+ + PO4 3-
If you need to increase Ca2+ but do not want to make bone, then you have got to decrease phosphate! Capiche? This really helped me out.
IQ is one of the best things Case is able to do and this was a great learning moment where I was able to gain some real insight from my peers! (Shout out to Tiffany).
TUESDAY: Prostates and True War Stories
Prostate and testicular tumors come in all shapes, sizes, colors and what not. The end. I was mildly traumatized, but it honestly wasn’t as bad as today’s lecture on HPV and vaginal ulcers and everything. People please live responsibly… I suppose the prostate stuff really is more out of your own control though.
Narrative Medicine was great this week because we read, “How to Tell a True War Story” by Tim O’Brien. He is one of my favorite writers because The Things They Carried, is one of my favorite books. You can tell a really good book when there is nothing about the premise that really connects with you until you open and read it. It is an amalgamation of “true” Vietnam War stories, and O’Brien makes fascinating and seemingly contradictory statements on what makes a “true” story true.
In one of the parts of the essay, he tells the story about how one of the 19 year old soldiers, stepped on a land mine and was blown into the trees. His comrades had to remove his remains from the branches. Afterwards, one of his friends, shot up an baby water buffalo and threw it into a well for “no reason.” I was kind of surprised by the unbalanced horror/concern students in my class had for the water buffalo in comparison to the soldier. They thought the soldier who mutilated it was “cruel.” Hmmm war is cruel. It was as if, what happened to his friend was, “normal” or “part of the plan” as the Joker put it in The Dark Knight. No one seems that shocked or horrified when a soldier dies. But a baby buffalo? Shut the front door!
I’m glad someone made the connection between the 19 year old soldier who died and the mutilated water buffalo…perhaps they aren’t so different. Perhaps they are both deserving of our sympathy…The hard part of O’Brien’s essay and book is that they may not be stories of things that happened exactly as they were written. After hearing this, people wonder, “Is this story true?”
Is it true?
The answer matters.
You’d feel cheated if it never happened. Without the grounding reality, it’s just a trite bit of puffery, pure Hollywood, untrue in the way all such stories are untrue. Yet even if it did happen—and maybe it did, anything’s possible—even then you know it can’t be true, because a true war story does not depend upon that kind of truth. Happeningness is irrelevant. A thing may
happen and be a total lie; another thing may not happen and be truer than the truth.
Check out more of Tim O’Brien’s essay here. It is so well written and worth the read.
How does this connect to a patient’s narrative? If a patient tells you their history of present illness and leaves out a few details or forgets the date of onset, or describes their pain as “dull” instead of “sharp” on accident, is their story still untrue? One must consider that although all the facts may not be the happening “truth,” within the patient’s story we can learn truths of who they are and the situations they lived through—maybe even more truths than a precise/accurate description of their symptoms.
It goes without saying, that medicine really concerns itself with the Truth, and as we search for it, we should keep these things in mind. The truth can be learned in varying ways.
WEDNESDAY: Cystic Fibrosis!
We had a “Medium Sized Group” or MSG session about Cystic Fibrosis. My IQ team along with another really lucked out because the two faculty teaching us about CF actually researched the disease. To be completely honest, CF has generally been of little interest to me. It is a autosomal recessive disease impacting the chlorine ion channels in some tissues—especially the lungs and makes breathing very difficult for people and there is a lot of mucus accumulation. The prognosis is generally poor and it usually impacts those who are Caucasian to some degree.
CF is almost always discussed in contrast to Sickle Cell Disease. CF happens mostly in white people. SCD happens mostly in black people. CF is autosomal recessive and so is SCD. The incidence of CF is much lower than SCD. The carrier frequency is 1/25 white people in the US while for SCD it is 1/9 black people. A little bit about the history of SCD.
A sickled cell was the first cell seen under a microscope. Linus Pauling and his colleagues were the first to describe SCD as a “molecular” disease in 1949. They believed that their work in understanding the structural chemistry of these cells with defective hemoglobin could convert medicine “into a real science.” Pauling got a Nobel Prize for this and his conversion of medicine into a “real science” had enormous implications for disease at large.
But honestly, beyond being a tool of academic interest, Sickle Cell disease has be drastically under-researched today in comparison to Cystic Fibrosis. Why? Well…think about who is affected.
So given what I know about these conditions—both not good and worth learning about—-I have generally felt annoyed with the inequality of research interest in SCD in comparison to its counterpart. This annoyance has kept me from learning about CF properly. Therefore, the MSG on cystic fibrosis and the weekly SEQ I decided to do on CF, helped me learn about this condition, and process some of my own baggage concerning SCD and the injustice in medical research and people just not caring about people different from them. What I’ve learned? Cystic fibrosis can be inherited non-classically such that there are different classes of mutations that can result in varying prognoses for those with CF. I was truly fascinated while learning about this, and realized that our biases can get in the way of learning.
Once we can identify and perhaps work through them, our eyes can be opened to see what is needed to be seen.
THURSDAY: Abdominal Exam…Never be too comfortable, SCANDAL
Ahh this was definitely my worst SIM week. The abdominal exam was the shortest one we have had to do so far, and I think I let that fact keep me from practicing as rigorously as usual. I forgot some ROS questions and to palpate the bladder, and was a bit disappointed with my performance.
Scandal happened at night.
It was okay. I was super happy that I was able to watch it live at an M2’s apartment! It was a fab time.
How to Get Away with Murder was even better!
At last, Friday is here. I went Edgewater to attend a dinner at two Christian ophtalmologists’ house. Dang, that house was nice. First time I have seen a suit of armor in a house…
The view of Lake Eerie was also spectacular.
In general, I had a good time. I was kind of confused by the ice breaker activity in which people shared where they had went on “mission trips.” Christians love mission trips. I could go on and on about this. I think it is a good and necessary thing to be missional but why does a mission trip automatically imply traveling to an impoverished country where the people are “so friendly” and have the faith of a “child”? Last time I checked, Cleveland is in need of a whole lot of salvation…
One of the most rewarding parts of the day for me was talking to a physician about the stress of medical school, and learning how to deal with anxiety.
I think we should all remember that although life is going to get “busier” it does not necessarily get worse. With each stage of life, we gain the skills to handle what is coming next.
SATURDAY: SNMA Regional Conference, Superior Pho, DUAL MONITORS!
SNMA had its regional northeastern Ohio conference. I only came for the picnic, but it was a good time meeting other medical students from the area. Ify and I also walked up these cool stairs. She says they are called the, “Elephant Steps.”
Later in the evening, Ify, Aaida and I went out to Superior Pho get get some pho! It was the first time I have actually tried Pho so I was not sure what to expect. However, Superior’s reputation was not unwarranted. It was sooo delicious and beautiful to look at.
Isn’t that gorgeous?
the PHOnomenal Ify We love curly-haired Aaida
All together now with “Avant Garde” lighting
Later that night, I tested out my new MONITOR! I’m really loving it and it is allowing me to open more windows and read my many PDFs easier! Hurray for productivity!
This is a Samsung 23-incher and was $180. Not too bad concerning monitors.
Prostate Pathology Made “Easy”
Sunday: Jen comes Home!
Originally I planned to see Gone with the Wind with the free tickets I won earlier in the week from Turner’s Classic Movies, but in the end, I stayed home and was productive! I also cleaned the apartment because after a week of being “home alone,” the place was a bit…messy…
I picked up Jen from the bus station, and worked for the rest of the day.
At the end of every post, I think about what I could have included in my weekly narrative—and what I could have left out.
Is my story true?
I’d like to think so.
How do you tell a true medical school story?
I’ll let you know when I figure that out.