KCMC

Today (6/30/2010), we visited the Kilimanjaro Christian Medical Centre (KCMC) for the first time. I spent $385US dollars to pay for housing ($150 a month for 6 weeks) and $140US for a residence permit. The rent also covers the cost of having a house cleaner, who comes in and does yard work, washes the dishes, makes the bed, etc. For an extra 5000 T/= (or T shillings) per week, she can wash and iron your clothes.

KCMC is a major teaching hospital with a medical school (one of three in Tanzania) and a nursing school. Many patients travel a great distance to receive care. Because Tanzania is a developing country, disparities are apparent. For example, because the surgery department has limited supplies, we were instructed to bring our own scrubs, masks, and caps if we intended to observe a surgery. Blood supplies are drastically low – I plan to donate blood soon. Furthermore, the internal medicine department lacks a working EKG machine, and because there is no full-time pathologist, pap smears aren’t given to test for cervical cancer (I will discuss this topic later).

Despite the disparities, the hospital is full of talented and caring people who truly work hard for the benefit of the patient. Unlike any other hospital I’ve seen, the campus has many open spaces and courtyards. In the middle of the main building, a grassy courtyard beautifies a hallway for doctors, nurses, assistants, and patients. Plus, you can see Mt. Kilimanjaro from the campus.

The next day, I start work in the obstetrics and gynecology (OB/GYN) department. The schedule varies. Some days I start at 7:30am with the morning reports; other days, I don’t need to arrive until 9am.

I can’t wait to start!

musings on anatomy

Anatomy has petrified me for years. However, as the semester progresses, appreciation replaces apprehension. I’m starting to love anatomy. Initially, the idea of memorizing minute details and foreign Latin-based words filled me with dismay. However, once I get past the plethora of those foreign words, everything becomes conceptually clear.

I make the subject easier for myself by relating it to my two interests: reading maps and learning languages.

The human body is a map chronicling a landscape paved with arteries, routed with nerves, and bordered by muscles. That must be why Dr. Frank Netter publishes an atlas of Human Anatomy instead of a book. The intricate curves of the brachial plexus (that exists in your arm pit) transforms into the twisting asphalt of I-75, I-94, and I-96 in Downtown Detroit; only a native (like me) can navigate that mess.

Though I hate memorization, paradoxically, I happen to love learning languages (as evidenced by my former post), which involves a lot of memorization. Juxtaposing anatomy to the French, Hebrew, or Russian I’ve studied makes memorizing the complex of nerves, roots, veins more bearable.

Today, I took a shower after anatomy lab to wash off the formaldehyde. In the mirror, I traced my latissimus dorsi to the intertubercular sulcus of my humerus (arm). The nearby outline of my pectoralis major revealed the position of my serratus anterior. Looking closely, found my cephalic vein appeared by my deltoid followed it down my arm. A month ago, all these were mere “body parts;” now, they develop meaning as I learn more about myself.

We’ll see how much I love anatomy after our first exam next week.

10,000

…the number of words one learns in their first year of medical school – from aortic aneurysm to zygapophyseal joint. That’s a lot of memorization!

In lecture, we learn the terminologies of anatomists, physiologists, biochemists, cell biologists, and geneticists. In our problem-based learning (PBL) sessions, we gain a command of Latin and Greek-based medical jargon – neoplasia versus hyperplasia; dysuria versus hyperuria; not to mention BUN, CBC, EENT, etc.

Juxtaposing this to learning a new language: we are immersed within the “culture,” learn what words “mean,” memorize, make flash cards, adopt a medical syntax for the new words, etc. Quite the concept, eh?

This adds to challenges of another personal goal: learning Russian. I have my reasons for doing so. Sometimes I get frustrated with my slow progress. (Я гаворю по русский не оцен хорошо!) I use Rosetta Stone and Pimsleur (both of which work well and I will comment on their effectiveness in future posts), and though I enjoy learning Russian, it is quite different from the French and Hebrew I’ve studied previously.

I must be patient. Learning two languages at the same time is difficult.

MD/8

...so I completed my first semester of medical school and can consider myself to be .125MD or one-eighth of an MD – that means if you come to me with eight diseases, I can only treat one of them. As I emerge from my medical cave into society, people often ask me the "how did it go?" question, which always catches me off guard. (“err… ok, I guess?” “It’s over.” “I didn’t die from studying too hard.”). Frankly, the semester went by in a blur. It flew from August to December, and I barely remember what happened in between.

For winter break, I emerged from my medical cave and we are on our way in a car from Michigan to the West Coast and back to New York to start the next semester. After my emergence, people also approach me for medical advice. Sometimes I can answer the question; sometimes I can’t (maybe I can only answer one-eighth of the questions I am asked?).

It’s a new experience that I think every professional student encounters. My friends in law school are experiencing the same types of almost-rhetorical questions. Though I sometimes feel overwhelmed with the required knowledge base to answer those questions, I appreciate the trust my friends and family place in me to listen to and address their concerns. It consistently reminds me how much I need to learn and of my changing position in society. Get ready, WolverineDoc.

Now, WolverineDoc must experience the wonders of the American West via car.

Lose that weight...

I got upset in my problem based learning (PBL) session the other day. For those who don’t know, PBL involves receiving a sample case from a fictitious patient who presents with certain symptoms and figuring out what disease the patient might have. I love this way of learning. It complements the lectures that sometimes make me want to gouge out my eyes with a dull spork, but I digress…

This week, we assessed the symptoms of a 55-year-old African-American female who presents with symptoms of diabetes mellitus (i.e., frequent urination, yeast infections, excessive thirst, etc.). While she presented to be an “overweight” (5’4, 170 lbs) female, she had a blood pressure of 124/80, which is regular. This puzzled some of my colleagues who expected the patient to automatically have high blood pressure because of her overweight Body Mass Index (BMI). This assumption (among others) triggered a thought I must share with cyberspace.

One can’t assume a patient is automatically unhealthy simply because a he or she is overweight. Being overweight doesn't ruin your health. Ingesting excessive sweets/sodium, not exercising, and smoking ruin your health. Now might there be a problem with her blood pressure? Perhaps, but I feel very uncomfortable assuming her issues result from her weight alone. In fact, a 2005 study showed that those in the overweight range (of the BMI) are at a lower risk of death than those who are considered to have a “normal weight.”

For me, this poor assumption is analogous to discussions on evolution. Many people who haven’t studied biological anthropology may incorrectly assume that men evolved from monkeys, yet they didn’t. Both men and monkeys evolved from a common ancestor (most likely from the early catarrhini family). Juxtaposing that to obesity and diabetes, many incorrectly assume that being "fat" causes diabetes. However, how would that explain the sizable number (no pun intended) of larger people who eat well, run, and are in very good shape (and don’t have diabetes). Living an unhealthy lifestyle (drinking pop/soda, eating fast food, not exercising) can lead to excessive weight gain and can lead to insulin resistance (diabetes).

I worry about this because focusing so much attention on larger people can shunt attention away from “normal” size patients. I spoke to a slim medical student about this, she confessed that many doctors overlook her eating or exercise habits because they assume that because she’s skinny, she’s in good shape. I, however, have always received tons of criticism from my doctors for my “overweight” BMI until I tell them that I lift weights, run 2 or 3 times a week, and was on the swim team in high school. (I also have a 32”/33” waist.)

As we delve into our patient’s social history, we find out that she never exercises, consumes tons of sugary soft drinks and fried foods. Bingo! We have a problem.

Now the work must continue. As I prepare a presentation on the etiology (causes) of Diabetes Mellitus Type II, I plan to erase the words “fat” or “obese” and replace it with “poor nutrition” and “lack of exercise.”

Wear and Tear...

As week 10 comes around and my seven-week preceptor session draws to a close, I find myself overwhelmed by the medical field – with all the drugs, diseases, signs, symptoms, tests, procedures, policies, paperwork, and patients. This craziness comes from the sea of information from my basic science classes and leaked into my “how to be a doctor” class that day, after which, I traveled to my preceptor’s office with several depressing and self-deprecating thoughts in my mind: How do doctors handle all this medicine drama? Can I handle all this? Am I a complete idiot? Should I quit medical school and join the circus?

After sharing these serious concerns with my preceptor, he suggested that I was being too hard on myself. Most students start medical school knowing very little, so an inferiority complex can easily develop. They feel as if every other student knows more material, studies more hours, drinks more coffee, etc. The stress is on, yet my preceptor assured me that I will learn everything I need to know to treat my patients. For that, I am grateful to have such a supportive preceptor.

Now it’s time for me to drink more coffee, so I can study more hours and learn more material.

Freshman 15

…describes a debilitating malady many undergraduate college first-years experience: gaining 15 pounds (or more!) in one’s first year of school. Sadly, this afflicts med-school first years as well.

I was warned. I’ve heard the stories, the complaints, the symptoms; hence, I’ve treated the freshman 15 as if it were the flu. I watch myself closely for signs of manifestation. I try protecting myself with diet and exercise, yet there’s only so much I can do. The symptoms have recently started to appear. Though I don’t weigh myself, I see slight changes in my torso. My stomach isn’t as flat as it used to be. I feel out of shape and less physically attractive. It’s freaking me out!

I realize the increased workload eats away my exercise time, so I've biked and ran less. The stress and sleep deprivation fuel my hunger for sweets, chocolate, and carbs. The lack of free time also prevents me from cooking healthier meals. I feel more compelled to save time by buying the cheapest, fastest food (usually pizza).

I also realize these are mere excuses, but it all comes with adjusting to a new lifestyle in a new environment. I’m now trying to find more efficient ways of incorporating physical activity into my life (i.e. taking the stairs, walking longer distances, etc), and ways to keep sweets, carbs, and sugar out of my life (buying the salad instead of the burger). Such commences my battle of the bulge.

In fact, yesterday, I biked 7 miles to Brooklyn to study at a coffee shop and biked 7 miles back. Now I'm off to the gym…

You know it's sad when...

you visit the Kandinsky exhibit at the Guggenheim with your partner and see nothing but cellular organelles-- Look! a golgi body!


Composition 9
by Wassily Kandinsky
(1936)

Sharing is caring

I hated other pre-meds in undergrad. Why? All the competition drove me insane!

At The University of Michigan exists a pre-med sub-culture filled with one-ups, let downs, weeding out, gunnering, competition to the extreme. Many colleges with a large number of pre-med students (Berkley, Northwestern, UTexas, The Ivy Leagues) are blessed with this sadomasochistic sub-culture, some worse than Michigan’s, sadly.

Hence, I avoided the chaos with English, Sociology, and Psychology majors. Instead of discussing how to cheat the med school admissions process, we spoke of social justice, race, literature, music, etc. It kept me sane for five years.

I even chose my current medical school because our tour guides affirmed the “chillness" of the atmosphere here. People worked together, shared notes, loved each other, didn’t care much about who gets honors, etc. (I realize these musings are naive, but work with me here.)

Now, I’m noticing competition in the air. Everyone studies by themselves or in hermetically tight clicks. People talk of getting better quiz grades than others. Classmates hold back in lecture or small group because they don’t want to sound stupid. Though these are normal behaviors or any class in the first month, it can easily go in the wrong, competitive direction, which make me nervous. So, to subside it, I’ve decided to share my lecture notes.

Small move, I know, but I hope it encourages others to share information with each other and work together without the fear of being wrong or sounding stupid. I sent my plasma membrane notes a few days ago, and soon a typed, organized outline on lipids will reside in everyone’s mailbox.

I hope it works. Let’s see. Now on to the wonders of protein folding.