Baptism by Formaldehyde

I cannot even count how many times I have begun a new post, only to panic halfway through about losing too much studying time. We just had our first final exam last Friday, and it was pretty much every bit as hectic and stressful as I anticipated. On Monday this week, we jumped right back into it, starting our Human Body 2 block with the great unveiling of our cadavers. From Friday morning to Monday evening, I have cycled through the entire gambit of emotion. The combination of the exam on Friday (basically a baptism by fire) and the meeting of our cadaver on Monday (a baptism in formaldehyde fumes) has finally made me feel like an actual medical student. That is: stressed, exhausted, excited-to-the-point-of-butterflies, exhausted, and stressed. We have launched officially from the undergraduate-ish topics of biochemistry, genetics, and cellular function to lectures that incorporate anatomy, physiology, histology, embryology, and more. Our focus in each class is on clinical scenarios and treatment plans. The increase in intensity and volume of material is definitely correlated with an increase in fascination on my part. But I’ll leave the personal updates there, for now.

I originally started this blog with the idea of helping other non-traditional applicants (and also traditional applicants) navigate the long and winding road to a medical school acceptance. I recently was invited to sit on a panel for pre-med students, and my passion to help individuals get into medical school resurfaced. It’s not that I think I’m some sort of spiritual guide or expert on the process; but coming from such a nontraditional background, I feel like I necessarily HAD to be more invested in the process than most of my fellow applicants. From the birth of my ambition to attend medical school to my acceptance, I had only 3 years to get everything figured out: pre-requisites, volunteering, letters of recommendation, medical mission work, research, shadowing, MCAT, applications, interviews, etc. The whole process takes strategy and careful planning. Between the eminent doctor shortage, about which the AAMC keeps warning us, and the reality that a shortage of doctors = a surplus of patients = unreasonable work hours for all physicians (current and future), I feel genuinely invested in helping other premeds figure out their best path into medical school. Whether that means answering questions, like I did at the premed panel earlier this week, or reading through application essays–I want to be involved! So hopefully, this post will mark the turning point in my blog, as I start directing the content more towards the premed audience.

Now, back to studying cardiovascular physiology… 🙂

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Fact: Medical School is Hard

I am still amazed every day by the sheer volume that we are learning. It’s week five. (But technically week four AND five, since the three missed days from the hurricane have been rolled into this week.) After covering 40 or so genetic conditions, including their symptoms, laboratory and clinical diagnostic techniques, common biological causes, inheritance patterns and implications, course of action for genetic counseling, DNA repair techniques implicated, treatment possibilities, and more–we have finally moved on to biochemistry. A lot of this will be familiar, but it’s still biochemistry–and about a whole semester’s worth packed into the last 3 weeks of this “HB1” block.

After these next three weeks, we will get 1 week for review, then we take our HB1 exams and move on to HB2, which covers anatomy and involves lots of cadaver bonding time.

I fluctuate between excitement and dread about this. Admittedly, I used to be terrified of death. I watched White Fang when I was 9ish, and spent weeks unable to leave my bed to go to the bathroom at night because I was worried that the blue-faced frozen dead guy who falls off the dog sled and into the icy lake had somehow transported through the TV screen and was lying beside my bed. (I never could even bring myself to look over the edge to confirm this, so I lied equally frozen in my bed and prayed my bladder wouldn’t rupture and kill me.)

So basically I’m hoping our first anatomy lab session falls on a day that I’m feeling ready to look at dead people. There’s like a 50% chance that it’ll be the right day.

Also, I’d say there’s about an 80% chance that I’ll be a vegetarian for the months between October and next May… Thanksgiving Tofu, here I come. 8)

There once was a nontraditional medical student who lived beside an international airport…

your plane flew just
overhead today
and I wonder if
you looked out of your window
if you saw the school of medicine
peeled back the roof, took
two flights down, opened
the heavy
wooden door of 217L, studied
the girl who existed, at least
in that moment, almost
entirely between her ears:

me.

I looked up in your shadow and realized
you are me
four years ago, fleeing
a country, an identity, a fleeting
feeling. you
are me four years ago, and yet
I wonder if you have a better view
from way up there and I wonder

if your window is big enough
or if you closed
the shade.

The Awe Initiation Factor

For only beginning our second week, it feels a lot like being in the middle of a semester.

You know the feeling: you’re carrying something heavy (a giant wooden desk, for instance), and you’re about halfway to where you’re trying to take it (a moving van, say). Your fingers start cramping, palms begin sweating; you have this vision of dropping it mid-stairway, right onto your toes…

So I’m about to dive deep into an all-(Sun)day study session, but first I want to share something near and dear to my heart: the iron-dependent regulation of transferrin-receptor (TfR) mRNA.

Are you rolling your eyes?

I don’t want to get into the nitty-gritty details. (I mean, I DO want to, I just don’t have time. Also, I already described it in detail to Hubs, and his reaction brought me down to earth again–God bless him for loving me.)

But basically, there is a special mechanism through which your cells control how much iron is brought into each cell. There is a specific little mRNA sequence (think of mRNA like Ikea instructions) that tells that cell to make a protein that brings extracellular iron into the cell. When the cell has too much iron, this mRNA piece needs to be told to stop making more iron-recruiters. But how? The mRNA contains these “weak” sequences that allow it to be degraded by the cell. (If we’re sticking with the Ikea metaphor, imagine that key words of your instructions are randomly flipped from English to Swedish.)

The coolest part is that, when iron levels are low, there are these special little protective caps called IRE-BP that bind to these weak “key words” and protect the mRNA from being degraded by the cell, thereby allowing the mRNA to keep commanding the cell to make theses iron-recruiting protein guys to raise the intracellular iron levels. (Or you to keep assembling your Ikea desk or whatever.)

So if you think about the complexity of this one process just for a moment, and think about how many things could go wrong (a mutation in the mRNA, a misfolded protein, a problem with the IRE-BPs, etc)–then back up and think of ALL the other things that that one cell requires to survive (calcium, sodium, water, magnesium–just read the back of a vitamin bottle).

Now back up further and think of how many many MANY cells you have in your body, and how different classes of different cells need different things at different levels–and some even have different regulatory pathways. I really don’t think anyone has to be as nerdy as I am to appreciate the awe-inspiring complexity of the human body. Considered this way, it’s really hard for me to think of life as anything other than Divinely created and organized. And absolutely amazing.

Drinking from a fire hose…while running behind the fire truck.

I’d say it’s a pretty accurate description of medical school. Last week was orientation, so this has been my first true week as a medical student. It’s definitely a fire hose of information!

Day 1: covered the lifecycle of the cell, had an overview of cellular models of disease, touched on anemia, leukemia, Alzheimer’s disease and a few other obscure genetic disorders related to malfunctions in DNA replication. Which brought us, then, to a lecture on DNA replication, some of the problems that can occur, the medical ramifications of these problems, and the cell’s method of preventing these problems…which naturally included a detailed peek at cell cycle checkpoints and cyclin-CDK pairings throughout the cell cycle. Oh, and we also went over different types of cell death and their causes and a few examples of associated diseases. Oh, and also a few diseases related to protein malformation…what am I missing?

Day 2: we had a case study on a theoretical patient who presented with fatigue, irritability, shortness of breath, dizziness, weight loss, tingling sensation in her legs, elevated pulse and no fever. Megaloplastic anemia resulting from a deficiency in vitamin B12. (Obvious. Right?) We discussed differential diagnoses, the relevance of the absence of a fever, the specific mistake in the cell cycle that leads to the development of hypersegmented neutrophils. We then had a solid review lecture on DNA transcription and translation–that wondrous journey that takes a DNA transcript and turns it into a protein. In the afternoon, we had our first partial patient exams (they call them “interviews”) where we practiced our new skills (derived from copious readings) for establishing empathy and patient trust via non-focused, open-ended questions before continuing onward to address the 7 characteristics of a symptom. Good stuff. (I’m not being sarcastic!)

As you can imagine, most of my free time is consumed with studying and preparing for the next day. But writing helps keep me sane. (And I prefer to be sane.) As does spending time with my incredible and supportive Hubs and our two rag-tag mastiffs–who, I might add, are fast becoming the boorish behemoths of our apartment complex. (The dogs, that is, not Hubs–who is still the GQ Model on the Block.)

So there. I’ve said my piece and made my first post as a medical student. Now it’s family time, then bedtime at, errrr, 9:00pm…)

CTE and Other Big Decisions

CTE: Commit to enroll. This is a deadline enforced by schools, typically about 1 month prior to the start of school.

Today I sent out my last official waitlist withdrawal notice. This last school of medicine responded within the hour, the email like a curt nod from a butler. An “It is done”-type reply with a monotone finality. Climactic in a nothing-actually-happened kind of way, but you still hear that slammed door echoing in the hallways of your ear.

In reality, it would be a bit late to get off the waitlist at this point. It certainly happens, and it’s hard not to keep thinking that moment is right around the corner. But Hubs and I have some other big decisions to make, and so it was time to move on. It’s really nice to have made my decision.

So now I’m glad to cross out all (major) checklist items except one: finding a place to live. The tricky thing is sneaking in the fact that we have two mastiffs… We HAD found a place. A cozy but modern house close to the school in a nice and safe neighborhood. We paid our deposit, and all was well. Until the owner, who had previously been totally agreeable to our dogs, told us that his insurance doesn’t cover mastiffs. This is hard for me believe, knowing the breed as I do. But okay. It wasn’t meant to be.

Actually, that’s really become my motto. At the point that things are out of my control, that final step at the tippy top of a staircase, there are only two options: meant to be or not.

And to come full circle, that’s the attitude it took to remove myself from a waitlist. If it were meant to be, it would have happened already. And that’s that.