CH2O

Water (H2O) and carbon (C) are the most basic components of life, the essence of something organic. However when combined together in a simple aldehyde (H2C=O) what remains is the curse of all first year medical students - formaldehyde. I have had to spend all summer surrounded by this substance as I completed an intensive anatomy course and now, one month into the official academic year, I am interacting almost daily with formaldehyde as a facilitate and tutor for gross anatomy. While I've been reassure formaldehyde is only mildly toxic (comparable to EtOH) when inhaled in low doses (as in a well ventilated anatomy lab) the symptoms of formaldehyde exposure are not nearly as pleasant as those following a glass of vino tinto - headaches, irritate eyes, a pungent-lingering odor, and cold or numb fingers. (Aldehydes evaporate quickly taking away body heat). Adjusting to the world of medicine is a process I would guess is not unlike beginning a long sailing voyage - you have to develop sea legs before achieving a sense of confidence and surefootedness. Surrounded by a foreign environment one must quickly immerse oneself in the vernacular and learn the ropes all the while feeling one's worst due to the effects of seasickness. For me formaldehyde brings out the worst. While I'm not over the bow returning my breakfast, I notice myself becoming more irritable and tense after a day in the lab; most likely due to the unpleasant smells, sense of cold and onset of mild headaches. This feeling is juxtaposed by the sense of awe at the human body and the sense of pride being surrounded by a group of peers whom are intelligent, hardworking, and passionate about making a difference in the world. While it is unlikely I can change how my body reacts to the affects of formaldehyde or more broadly, the stresses of adapting to a new environment, I am learning how to navigate through these stressors and take time to decompress and reenergize while still sailing onwards. I hope as time goes by I get better at it and develop my medical "sea legs". Until then, at least I know we're all in the same boat.

Good Grief

Ecclesiastes 1:18- For in much wisdom there is much sorrow, and he who stores up knowledge stores up grief.

During high school in preparation for the AP English exam we had a prompt to support or refute the verse from Ecclesiastes above. As a timed essay, it was a test of critical thinking skills and persuasive writing. I remember refuting the premise of this claim arguing that knowledge is power and the potential good outweighed any potential grief. Now nearly six years later, and 2/3rds into a human gross anatomy course I have been reminded of this verse and am tempted to modify my previous analysis! Indeed my limited pre-medical school understanding of anatomy was more than sufficient for the past 23 years although I was (blissfully?) unaware of the extent of my ignorance. After a few particularly long and grueling days in the laboratory I am now beginning to appreciate the nuances of the lower extremities but instead of mitigating my stress level, it is increasing due to the realization of how much I still don't know and the impending test in a week. A significant component of medical school anatomy is clinical correlations. While I generally appreciate the change in context of gross anatomy from erudite Latin to practical application, two unintended consequences become evident with this approach. First, our better understanding of anatomy comes at the expense of someone else's suffering and injuries; second, limited knowledge if fodder for hypochondria. Two weeks ago, hitting your funny bone on the table was painful but benign- at the risk of sounding insensitive, it could even be considered funny- if it happens to someone else. Now with the simple understanding that it is crushing the ulnar nerve against a table and the medial epicondyle and when done with enough force could cause serious nerve damage and motor deficits- it removes any element of humor. How then does gross anatomy fit into the context of Ecclesiastes?

The answer I believe lies in the insightful wisdom of Charles Schulz and the illustrations of Charlie Brown. Whenever Charlie becomes frustrated he exclaims "Good Grief!" While some may argue that this juxtaposition is an oxymoron, I would offer that at least in academic pursuits grief can be good. As Charlie navigates the world of friendships and school (waah wah wah, wah wah wah waah) he learns life lessons and gains wisdom and knowledge (the good) through his personal trials and tribulations (the grief). One without the other would be incomplete. A medical career is defined by critical thinking, persuasive communication, and good grief. Knowledge and sorrow parallel mystery and joy- that is the true sign that the doctor is in.



Image from http://candygourlay.com/blog/images/peanuts.gif

Note: the waah wah wah sounds produced in Peanut animations is the product of a muted trumpet.
http://www.everything2.com/index.pl?node_id=117867

Dishes

It's Friday night and I've spent the last hour cleaning my living room and bedroom. My dishes are done and my bed is made- a facade to mask the lack of order in my mind as I've been grappling with memorizing anatomical terms. With an exam on the horizon, stress has started to kick in and I've forgotten how I best deal with it. To be metacognitive for a moment, it's interesting how when I become hyperfocused on one thing, "distractors" tend to be more annoying and must be fixed before I can continue the task at hand. Tonight, the distractor was dishes. As much as I'd like to blame these distractors for creating more stress, in reality, they are not all detrimental. For instance, they remind me of the world at large, outside the niche I've been in since coming to Pomona. We get new/clean lab coats every Wednesday for dissection. It is one of the most blissful simple pleasures that exist and because of the fourth of July, this week the schedule of cleaning changed by a day. The anatomy lab coordinator came on Tuesday to inform us of this schedule change mentioning "the holiday" as the cause. It took me several minutes to realize that we are already at the end of June and the holiday was reference to July 4th. Being reminded of the outside world is a benefit- just make sure we get clean coats! Secondly, distractions can be generally productive- putting gas into the car, cleaning, grocery shopping, eating, etc. are all lifestyle sustaining chores that should be done regardless of an exam schedule. At the end of the dissection Tuesday we ran out of gloves. My lab group, being the studious students that we are, decided to have a fast dinner and form a study group immediately after leaving the lab and go to the bookstore in the morning (being almost 7, the bookstore had already closed for the day) for more gloves. The next day, we discovered that the bookstore was closed for summer inventory for the rest of the week! (A sign and email announced said closure a week in advanced but being singley focused, we all neglected this useful information). Bottom line- No gloves. Luckily, I was able to beg and borrow a pair for the days dissection. Needless to say, Wednesday night included a shopping trip to restock on essentials- 600 medium gloves. In retrospect, dealing with chores and distractors, sooner rather than later and not letting them build up is worth the sacrifice in cram time. Tonight, while I can't boast a deep understanding of the flexor digitorum profundus muscle of the forearm, I do have clean dishes.

Monkey count

This week has been one of the busiest weeks in my recent past, but not due to a full agenda! Anatomy has been (almost) all consuming yet that doesn't mean that my week was all work and no play. Friday night, in celebration of completing our first official week of med school, my dissection group plus one went out for happy hour appetizers/dinner at the Monteclair plaza shopping center. It was wonderful to relate with one another without the linger of formalin and to avoid intentionally the subject of anatomy (well almost ;)). Interestingly, of the five of us, only two were born in the US-and of them, one moved to Taiwan when she was young, and the other just returned (the weekend before classes started!) from a year abroad in China. Of the group, I was conversationally fluent in the fewest number of languages, yet the only one who spoke Spanish! As we are learning about the complexity of the human body, it is equally fascinating to remember the complexity and variety in our human experiences and backgrounds and interesting to see how individually, these events brought us to a career in medicine. As challenging as ISACs is proving to be, the subject matter is never boring and getting to know the other students has made the experience well worthwhile.

On Saturday, we had a homemade-esq/potluck dinner at the Helix. Since most of the day was spent studying and doing chores, again the evening had a social rather than academic flair. After a wonderful dinner, the evening vanished as we played variations of group icebreaker games: mafia & psychiatrist, and riddles: green glass door, monkey count, & rabbit hop. It was downright hillarious watching and listening to one another defend their mofia accusations or struggle with the riddles. Being a sucker for group games and icebreakers, I always love to learn new variations and am looking forward to the next opportunity to use these new riddles on unsuspecting victims!

Pomp and Circumstance

Today marks the end of the second day of medical school. Based on the pace of the anatomy course I will not be able to devote much time to reflection--mainly memorization, memorization, dissection, and more memorization. I did want to share one story though. Yesterday morning was orientation, the calm before the storm. We got our parking passes, locker keys, and were ushered to stations set up for the admissions (I still need some vaccinations :() Bursars Office and financial aid. Finally, we went over to the library and got our photo student IDs. On our way back from getting our IDs we made a detour to the media department of WesternU, donned a cap and gown, and had our graduation pictures taken. Yes, I enrolled and graduated within 2 hours. Logistics are always a tricky beast but evidently with 200 students scattered across the state, country, and world in their fourth year, returning to campus can be a challenge for something as trivial as a graduation photo. Western's solution? Take the photos during orientation. As strange as it seems, there is something oddly comforting that they expect us to remain until graduation...because as of tonight, I feel more like a boat out of water- it's not smooth sailing yet.

The beauty and complexity of the human body is overwhelmingly evident taking a cadaver lab. Classes started immediately after the photos with an introduction to anatomy and a 3 hour anatomy lab, where we opened the cadaver. I didn't faint or get sick, and found myself enjoying the experience. Steps in the right direction! Today, the atmosphere was still comfortable but there is no time for a learning curve! We covered two lectures on superficial and deep back muscles in the morning with corresponding labs in the afternoon. Tomorrow is the vertebrae and spinal cord. Back to the books!

A room of one's own?

Virgina Wolf in 1929 thought a room of one's own was a requisite to independent thought and the ability to write fiction. I am sure that she never considered my situation the last week; moving into an apartment, moving out of a condo, and keeping my room at the house clean and organized. Shelter is an essential component of survival, in extreme conditions even more important than food or water but its importance to survival does little to mitigate stress involved with moving. While in Denver, chatting with my friends, it occurred to me that most of us graduates, one year removed, are moving-all for different reasons-relationships/marriage, returning to school, promotions at work leading to buying over renting. In fact, the "wow we're old" moment happened when Matt, Jen & Ian, Nashwa, and I were all discussing our housing search sagas and looking at home decor options (Ian-even though you don't have a basement, I think you should stick to your guns and go with a Broncos Orange accent wall-regardless of how it looks you will have a great story...and you can always repaint in a year). I took possession of my apartment keys on Friday afternoon and all weekend my family and I spent moving furniture, shopping for household staples, and packing and unpacking. Monday was my first night sleeping in Pomona which was great but emphasized the items I had forgot to pack (like a pillow case-at least I remembered the other linens). In the midst of the chaos of moving I've realized somethings: One, I own too much stuff and need a better appreciation for what is essential versus cosmetic; two, moving is a prelude to bigger and better, to new adventures and opportunities; three, home is an attitude not a location; and four, friends (and family) are invaluable. Whether it's commiserating about moving woes, lending a hand carrying a couch or dresser, or providing an escape to ignore the mess and just chat over coffee (tea) or on the phone about non-moving topics, friends provide stability in the midst of chaos of any form. And even though it may be challenging at first- moving forces you to make new friends and foster old friendships. I am anxious to feel settled again but am doing my best to enjoy the process of adapting to a new environment, making new friends, and balancing my attachments to the places I am leaving behind.

Attention Deficit

Do not let silence suggest a lack of activities in my life, rather a limited ability to focus. I have two introductory paragraphs for incomplete posts that were well intended but short lived.
I will include the "unpublished" beginnings with the caveat that a chronological reconstruction is not my intent but to delete the partial posts seems wasteful. Langston Hughes like- a dream deferred....or does it explode?


Dated 5/17
Title: Rollercoaster

I have had an amazing start to this week beginning with mother's day brunch in Laguna Beach Sunday, a visit to Disneyland Monday, work/birthday shopping for Nat's wife's 85th birthday Tuesday, and Universal Studios today. My aunt and uncle from Phoenix are in town on an amusement park week-long vacation with their grandchildren (3&5) and I have been fortunate to be able to tag along, schedule permitting. The week continues to go uphill as I have officially registered for the Intensive summer anatomy course and fall term at Western University and leave tomorrow after work for Denver. Having a full schedule has reminded me how much more productive and happier I am when I am busy, an interesting spin on the rest and relax theory.



Dated 5/27
Caldona

I often wonder what will be my legacy. Granted, that needs to be put into the context of a twenty three year old not quite sure of the future but making apparently life altering decisions- career choices, med school, travel. The past few weeks have not added much clarity into this endeavor but they have been truly rewarding and have provided thought provoking insights. Let me start off with a brief calendar since Mother's Day Sunday. Mother's Day Sunday consisted of a brunch at The Cottage in Laguna Beach, Monday was Disneyland with Todd, Janine, and their grandchildren (3&5), Tuesday was work-preparation for Lotte's 85th birthday, Wednesday was Universal studios (Curious George is one nice monkey!), Thursday was training my caregiver replacement and flight to Denver, Friday was spent visiting DU and in the evening celebrating with friends downtown, Saturday was recovering and another college-esq bbq party, Sunday was the Rockies game, Monday was Jrus and a dinner fiesta before returning to Santa Ana, Tuesday was work and last day of training, Wednesday
Thursday was work and picking up the Hoffman son and his family, Friday was Ikea, Saturday was babysitting, which leads us to today, two weeks later.
Not that a day by day account means much to others but as is evident by the schedule, it has been a full few weeks. What does this have to do with legacy?

To add a limited amount of clarity I will create a back story for the essential elements- First, Curious George provided free popcorn to the grandkids only because they were cute and hugged him. I wonder if Mickey is ever so generous? Second...the Rockies lost Royally to the Kansas City Royals after going into too many extra innings. Saturday was babysitting the Hoffman's grandkids so the adults could have an grown up night-and I was happy to be more a kid than adult with an excuse to play nok-hock, the precursor to air hockey and Nintendo Wii sports. Now to resolve the cliff hanger: legacy.

My grandpa returned home a week ago Wednesday and on his last night, he joined me on the piano to teach me an old time favorite song: Caldona, Caldona, What makes your big head so big? My grandpa is a man of many talents and a wealth of life experiences, but his piano music will be his legacy in my mind (that and his beef jerkey). While my parents watched the news Grandpa played Caldona repeatedly, his fingers filling in the music where his memory had lost the lyrics. Fascinating how procedural memory can outlast declarative memory impairments. While I was not able to pick up the melody and only learned the first line of the chorus, being in the moment with my grandpa was worth every second. I don't know what my legacy will be- likely different things to different people- but I hope some things I do will inspire others and create shared memories like the piano does for my grandfather.

And now a clean slate for a new post!