Neuro Clinical Correlations

Today was another double seminar day. The first one was about the genetics of dementia, and for the second they showed us video clips of patients with various movement disorders. I liked the genetics seminar, which was a case with a sort of surprise conclusion. The other one was ok, but somehow I just couldn't keep focused. Maybe it's just a matter of it being the last hour of class and the room being nice and dark.

In the afternoon, we had two clinical correlations. The first one involved examining a patient with multiple sclerosis in small groups, which was interesting. But I felt sorry for the patient, who seemed to be pretty tired and kept dozing off in between getting various joints and muscles prodded and poked by us. Afterward, we got an hour-long seminar about MS, which wasn't bad, but it was too long. We had several questions for the speaker, and he had clearly not built in time for questions in his talk. So he started getting a little testy with us for asking so many questions, and we wound up arriving at the EMG lab about 20 minutes late.

EMG stands for electromyography, which is a fancy word for testing the electrical conduction in muscles. They asked us to volunteer for some of the tests, and I did one called a QSART where they administered acetylcholine (a neurotransmitter) to my skin and measured how much it made me sweat. This tests the small nerve fibers that are attached to the sweat glands. I am apparently a slow sweater, because we had to wait a few minutes before anything happened. It doesn't make you sweat gallons or anything--they just collected on the order of a nanoliter of sweat, which is 1 x 10^-9 liters. Two of my classmates did the other tests, one to test breathing and one to test pupillary reflexes. That pupillary one was really cool. We could see his eyes on the computer screen, and when the light flashed, his pupils would contract.

Afterward, we went to a second room to do nerve conduction studies. No one wanted to volunteer, so I did those too. First, they put two electrodes on my hand, and when they then applied a current, it made the muscle contract. That test looks to see if my nerve cells have lost their myelin in some segments. (Myelin is the "insulation" that covers your nerve cells.) It's kind of a weird feeling, because each time the tech turned on the current, my thumb would jerk, and I had no control over it whatsoever. It didn't really hurt though until they moved the current up to my elbow and made my whole arm move. That felt a lot like banging my funny bone, and it was not too pleasant. The second test involved sticking a needle into my thumb muscle. That test is to look for loss or degeneration of my nerve cell axons. The needle is really small, so it didn't really hurt, and the tech said my readings were normal for a young adult. What a relief!

Officially Accepted to Grad School

So far, this week has been way intense. We are having double seminars every day again, and double reading too. Sigh. But the seminars have continued to be good on the whole. Yesterday we covered neurodegenerative diseases, and today we did inflammation and infection in the central nervous system. We also had a neuroanatomy session instead of FCM, which is both good and bad. It's good because it was more useful and interesting than an FCM seminar would have been, but it's bad because we had to read forty pages of neuroanatomy on top of all the reading for the other two seminars. Double sigh. My PBL learning objective for Wednesday is about the pathophysiology of tremors.

Clinic this afternoon was really busy. I saw five patients instead of the usual four. I don't know if my preceptor's secretary is scheduling certain patients this way on purpose, but it's uncanny how often I see a patient whose condition is related to whatever we're studying in school at the time. We're covering movement disorders like Parkinson's Disease and multiple sclerosis this week, and what do you know, I had an MS patient in clinic today. I did a neuro exam on the patient, not only because I need to practice doing the neuro exam, but also because there were actually some abnormal findings, mainly cerebellar (having to do with walking and balance). This morning, I also practiced doing some of the mini-mental status exam on one of the first years who had said he was worried about his mental faculties. He is not demented, at least as far as I got in testing him. ;-)

Finally, I am proud to say that I have officially been accepted to the Case Western Reserve University School of Graduate Studies. They sent me an official acceptance letter and everything. It's pretty funny actually, especially the second paragraph:

Dear CCLCMer,

Your credentials for admission to graduate study in the MS/MD program offered through the Clinical Research Scholars Program and the Cleveland Clinic Lerner College of Medicine have been reviewed. I am pleased to inform you that you have been retroactively admitted to this program with full standing for the term beginning August 27, 2007.

I regret that it will not be possible to provide you with an assistantship or fellowship. We have many more applicants for such appointments than we can provide, and our inability to offer you financial aid is no reflection on your promise as a graduate student.

I can't really complain about not getting financial aid. First of all, I didn't even know that I could apply for an assistantship, never mind actually applying for one. Second of all, I'm not actually paying for this MS because the grad classes are included in our med school tuition, so it would be pretty funny if the grad school started giving me financial aid too. All in all, I guess I just should be glad the grad school didn't decide that the med school had made a mistake two years ago when the med school admitted me! :-P

Already Sick of Step I

I forgot to mention on Wednesday that you should never tangle with a psychiatrist, because they will always get the last word. When Dean Franco was giving one of our coma seminars, I asked her how she could tell if the patient actually wasn't paying attention due to delirium versus for some other reason. She said if they weren't paying attention for any reason, then it was an alteration of consciousness. So I said, "No, I mean, what if you're asking me where I am or the date, and I just don't want to answer your questions?" Much to the amusement of my classmates, she replied, "Then it means you have a personality disorder!"

Yesterday wasn't terribly eventful. I had my MS class in the morning, though it was kind of hard to get up, and I spent the rest of the day working on my learning objective and trying to catch up on some reading.

Today we had a really good PBL session, probably one of the best we've done all block. The learning objectives were good, and the discussion was good. But no one from the administration came today to see us! Our seminars were on brain trauma and brain tumors. They were good too. I can't believe how much more I'm enjoying neuro this year versus last year. I don't know if the seminars are really just that much better, or the pathology is just more interesting, or I'm just feeling more comfortable with the material because of having studied neuro over the summer, or what.

Our ARM session today was, to put it mildly, simply awful. The school has decided to have us do little research projects where we come up with hypotheses and objectives and who knows what else at various points throughout the year, and today was the first one of those sessions. So we met in our PBL groups, and we were supposed to come up with an experiment based on our PBL case from this week. That has to be the most ridiculous way to come up with a research idea that I've ever heard. If you're wanting to come up with a research project and write a grant proposal, you don't start by thinking up methodology and making up a hypothesis! You start by reading the literature in that area so that you even understand what the current issues are in that field! On the bright side, I have a whole week to think of a way to give constructive criticism about this before we fill out the feedback sheet next Friday at the end of PBL. :-P

Dr. Prayson, who is a neuropathologist and also our new Assistant Dean of Students, invited anyone who was interested to go over the the CCF morgue and look at some brain pathology. About ten of us went this afternoon, and it was really awesome. We saw tumors, infarcts, hemorrhages, all kinds of interesting stuff that we had been learning about this week. One of the brains belonged to a young child, which was a little sad though. But overall, I got so much out of it in terms of learning the anatomy and pathology that I asked him about coming in to see an autopsy some time. He said that we were definitely welcome to do that if we wanted, and that some of the upperclassmen had done it in previous years. I don't know when I will have time to go, and it's kind of hard to set up a time anyway because patients don't exactly die and require autopsies on a set schedule. Maybe I can do it this summer after I take Step I.

Speaking of which, we got an email earlier in the week about attending a session this evening by some of the upperclassmen to give us advice on preparing for Step I. It was from 5:15-6:45 today. Although I felt kind of bad because of how nice the third and fourth years were to do this for us, I decided not to go. I was just too tired, and I also have come to realize that I really don't want to hear a single thing more about Step I at this point. It's bad enough that we have to register for it now, in October, when we aren't even taking it for another eight months. (The reason why we have to register now is that the Case UP students take the test four months earlier than we do, at the beginning of March.) But it's making me feel more stressed and anxious to be talking about studying for it now, when I don't have time to study for it and when I haven't learned enough path yet to even make it worth studying for it. I'm planning to start studying in January, and I don't want to think about it any more between now and then. Please, just give me my last two months of USMLE ignorant bliss!

For those of you who are premeds, don't complain about how much the MCAT costs, because the registration fee for Step I will set you back a cool $480, and Step II is even worse. For those of you who are CCLCM first years, start saving up. I didn't realize that we were going to have to register this early, right before the holidays, and I did not budget that $480 for this semester. :-(

Crazy Daze

This week is just absolutely killing me, although today was a pretty good day as far as school goes. Our PBL group was being observed by one of the administration people this morning. I don't know what it is about us being watched, but somehow it does something to the group dynamics and makes us all act even weirder than we usually do. :-P My learning objective for Friday is on reading EEGs. Our seminars this morning were both about coma, and they were really good. I have to say that overall, this year's NMS block is vastly better than last year's was.

In the afternoon, I had my clinical skills course. First, we had to practice interviewing standardized patients about their sexual history. Most of it is pretty straightforward, but some of the examples we had to read were a little ridiculous. For example, there was one where the patient was arthritic, and the doctor asked if the patient could open their legs to have sex. I read that one and thought, there is no way I will ever ask any arthritic patient that question! Do I look like Dr. Kinsey or Dr. Ruth? I came here to be a clinical researcher, not a sex therapist!

The standardized patients were awesome though. The one I had was playing a lesbian with a rash on her groin, and the interview was pretty uneventful. I asked her about her sexual activity, partners, using protection, satisfaction with her sex life, if anyone was hurting her or forcing her to do anything she didn't want to do, etc. Some of my classmates apparently got treated to detailed descriptions of lesbian sex toys, but I didn't really give my actress too much of an opportunity to go into a lot of details. :-P It felt a lot more awkward doing the interview in class than it ever does in clinic. Having an audience of a physician, a shrink, and three of your classmates watching you interview this person on what is probably the most sensitive subject out there is kind of weird, even though it's all pretend. We got through it all right, but no one ever said that being professional all the time is easy. ;-)

Afterward, we had a Clinical Correlation on impaired physicians, which was AWESOME. Several physicians and nurses who were recovering addicts came to speak with us in small groups about their experiences. Most had been alcoholics, but some had been addicted to opioids or other drugs. They answered our questions about how their addiction had affected their professional and personal lives, and we talked about Alcoholics Anonymous as well. Some of these people attend AA or NA (Narcotics Anonymous) meetings every single day, up to four meetings per day. The main things I learned from this were that being isolated from others and feeling like they were "in control" were two of the biggest risk factors for becoming an addict, or relapsing after getting clean. They also mentioned that statistically, odds are that three or four people in my class of 32 will become addicts or have problems with alcohol or other drugs. That really made their stories seem even more pertinent to us.

This evening, I came home and wrote my paper for class tomorrow. It wound up taking about three and a half hours. I don't like writing papers at the last minute, and I am just so happy that I got it done in time, even though I didn't have a chance to do any of my reading for med school this evening. I can't do it now either, because my class is at 7 AM tomorrow. Sigh.

Round Two of Neuro Block

I had a lot of work to catch up on from last week over the weekend, which meant that I spent most of a very beautiful fall weekend indoors reading about addiction. It didn't quite drive me to drink, and maybe there's a future career for me here, because I actually got all of the SAQs right. (The SAQs are those multiple guess questions we have to do each week.) I have never done that before. The less good part is that I didn't really have much chance to do this week's reading, which means I am as much behind so far this week as ever. Plus, I have a paper due for my MS class on Thursday, so it's not going to be an easy week.

Monday we started our new PBL case, and the patient is in a coma. That is our theme for this week in general. The neuro faculty have been doubling up on the seminars, where we have two one-hour seminars instead of one two-hour seminar each day. The bad thing about that is that they're also assigning us double the reading in a lot of cases. The seminars have been very good though. Yesterday's were on the anatomy and pathology of stroke. The other good thing is that the readings overlap in topic quite a bit, so I am not totally lost in class even though I've been coming in having only finished half of the assigned reading for each seminar.

Today we had a neuroanatomy session. Like last time, they divided us into two groups. One part reviewed the vasculature and ventricles of the brain using models and preserved brains, and the other was a series of questions and cases. The FCM session afterward was about surrogate decision making, which we had already talked about once last year. It wasn't the greatest FCM session, but it wasn't absolutely horrible either.

I had clinic this afternoon, and it wound up being a busy day. The most interesting patient I saw was a guy who was in for a follow-up for hypertension. That didn't sound too exciting initially. But while I was taking his history, he was telling me about his life. It turned out that he was a retired garbage collector. He never went to high school, and after he retired he decided to start taking GED classes. He is old enough to be most of his classmates' father or even grandfather, but he said he was determined to pass the test and earn a high school diploma. I thought that was incredibly impressive and inspiring. When I presented his history afterward, I was amazed to learn that my preceptor, who has cared for this man for several years, never knew that he only had an eighth grade education or that he was working on earning a GED. My preceptor commented that it was common for doctors to just hand printed instructions to patients without ever considering that some patients might not be able to read them. This just proves the point that not obtaining a patient's education level and occupation as part of the history really can affect the doctor's ability to provide the best possible care for that patient.

Back to School

I got home last night from my conference. It was really good, but also really exhausting. I have come to the realization that it is not very much fun to go to a conference as a second year medical student in the middle of an organ system block. The thing is, the psych profs are not giving me any extensions to turn my work in late or anything, so I had to spend several hours every morning and evening doing my reading and homework for school while all of the residents and fellows were going out having fun and sightseeing. I did manage to do a bit of sightseeing myself, but I definitely didn't have anywhere near as much fun as everyone else did. On the funny side, my PI commented to me that he was glad I came because I probably learned more at the meeting than I would have learned if I had stayed in Cleveland. I said I knew that I had definitely learned more than I would have otherwise, because I still had to do all of the assignments for school anyway, PLUS I attended a bunch of talks at the meeting. :-P

This morning we had PBL. I had been reading the case from the conference and had emailed some ideas and articles to the other members of my group, so I had a clue about what was going on even though I missed Monday and Wednesday. We have decided to be more organized and start having someone be the official board scribe each week. We also agreed that we would go back to doing formal learning objectives from now on.

The seminar today was about personality disorders. It's really funny, but as I was reading about the personality disorders yesterday and listening to the seminar today, I couldn't help but think about all of the people I have met in my life who would fit into one or another personality disorder category. I think probably everyone does this, but it was funny how many people I could say to myself, "hmm, yeah, he IS kind of borderline personality with features of anti-social personality." Yesterday on the plane, this surfer dude was sitting next to me. He saw the article I was reading about personality disorders for today's class and said that probably several of the categories would apply to him. I told him not to worry, substance abuse wasn't a personality disorder. He just kind of looked at me, so then I had to explain about the DSM axes and that personality disorders were a completely different category than being a pothead. Once he understood that he doesn't have a personality disorder (Axis II) because substance abuse is lumped in Axis I with things like psychotic disorders and dementia, he said, "oh, good, I'm really glad I'm not crazy." It made for a rather interesting conversation until he finally passed out after downing his third or fourth gin and tonic.

Our ARM seminar today was kind of boring, and I had a hard time focusing and paying attention the whole time. It was supposed to be about addiction, but instead it was about how some variant of the GABA ion channel seems to cause epilepsy in rats who were irradiated in the womb. Besides the fact that it's kind of cruel to irradiate pregnant rats, I'm not sure how well this rat model even mimics the human disease. The speaker did do studies on human tissue from epileptic patients as well, but he used "non-epileptic" tissue from these same patients as his controls. I wonder if non-epileptic tissue from epileptic patients is actually equivalent to normal brain tissue from non-epileptic patients? It's not like you could take some brain tissue out of a normal person and find out!

End of a Hectic Week

I'm leaving for my conference tomorrow! I just finished packing my suitcase, including my suit, which I haven't worn since I was interviewing for medical school two years ago. :-P The entire week has just been so crazy because I had to do this week's school work, get prepared for the conference, and collect up next week's assignments to take with me.

One of next week's assignments is for us to attend an Alcoholics Anonymous (AA) meeting. I went to one at a church near CCF after my MS class yesterday morning with two of my classmates. It was a very good experience, much better than I could have possibly anticipated. We met some regulars who have been coming to AA meetings for several decades. Others were first-time attendees like we were. We told the AA members that we are medical students at the Clinic, we are studying addiction and alcoholism in school, and we want to learn more about how to help our alcoholic patients beat their addiction. I wasn't sure how the regulars would feel about us coming, but they seemed happy to have us there. Several of them even came up to us afterward and talked to us more about their lives, and they invited us to come back again for another meeting whenever we wanted.

Yesterday was just a whirlwind. After the AA meeting, I got my PBL evals finished since they were due today, and I finished logging in all of my patients from Wednesday's peds clinic. It turns out that I saw EIGHT patients. No wonder I was so exhausted--that's twice as many as I see on a normal clinic day in IM! I also prepared my PBL learning objective, which was on adolescent depression.

Our seminar this morning was about sleep, and within a few minutes after it began, I was very tempted to go to sleep. Good thing that 3-57 (the library room where we have our classes) is so cold, or I really might have fallen asleep. The ARM (almost called it POD again!) talk today was kind of boring too. It was about preventing the blood vessels over the brain from spasming and leading to stroke in patients who have just had an aneurysm in the brain. That is an interesting topic, but for some reason the session turned into a discussion between the speaker and the professor in charge of the seminar series. Last year, the prof in charge hardly ever spoke, because the sessions are supposed to be for the students to interact with the faculty, not for the faculty to interact with each other. Not very cool.

There was a neuro histology review session this afternoon. But it was optional, so I opted not to go. Neuro histology wasn't so interesting the first time around that I wanted to go through it again, and I had enough other stuff to do.

I want to take the time to thank those of you who have donated to my Blogger Challenge this past week. So far we have raised $83 toward our goal of $951 to buy a skeleton model and books for underprivileged middle school children. If any of you other readers would like to find out more about my Blogger Challenge or help out, please click here.

Adolescent Medicine

We had PBL and a seminar on bipolar disorders this morning. The seminar wound up being pretty good, even though the speaker basically didn't cover anticonvulsant drugs at all like he was supposed to do.

In the afternoon, I had peds clinic. I was working with an adolescent medicine specialist. I went in there thinking, "Oh, great, yet another exciting afternoon of well child visits." I figured maybe if I was lucky there would be a few sore throats or earaches. But this clinic was awesome, probably the best clinic day I've ever had. My patients were all teens, and most of them had eating disorders. One was also hearing voices. They were a lot like the kid we've been reading about in this week's PBL case. I know everyone has their share of teenage angst, but not like this. These patients really need help. It was incredibly interesting and also very sad to hear their stories and how much they suffer with body image issues and other problems. I definitely identified with several of them. One patient in particular wanted to go to medical school and even knew all about CCLCM.

I was utterly exhausted by the end of the afternoon. I think today was a lot more emotional for me since I was seeing teens. It was really intense and fast-paced and just an all-around great experience. I am doing my next peds clinic with this same doctor. I'm really not all that interested in going into peds. But if I did do peds, I'd definitely do adolescent medicine!

Classes and Clinic

Our PBL case this week is pretty interesting, particularly because it keeps getting more complicated and taking unexpected turns. Also, we are supposed to be meeting a patient who has the disease the patient in the PBL case has after Friday's session. Yesterday's seminar was given jointly by a psychiatrist and a psychologist. It was ok, but they could have made it more detailed. I don't know if it's just me, but sometimes it seems like the psych people spend an awful lot of time justifying their field and the work they do. The only other interesting thing that happened yesterday is that I submitted my poster to the CCF art department for printing after class. It will be ready for Friday.

This morning, we had an anatomy session covering neuropsych. The first half went over pictures from our book, and we were asked to locate structures on drawings and brain models for the second half. I only got about a third of the reading done in time for today's session because for some reason, the assignment didn't get put up on the portal until yesterday afternoon. I really hate when they give us the assignments last minute like that. I had actually been more or less keeping up with the reading so far this block until today. :-P

The FCM session was about professionalism, and my small group had a pretty interesting discussion about what to do with patients you just don't like, or patients who you feel you really can't help. The large group talk was all about the life of William Osler, and I should have just skipped it.

My clinic preceptor's secretary forgot to email me to let me know that my preceptor wouldn't be in clinic today. So when I showed up clueless, one of the nurses told me I could just go home. But I didn't want to skip clinic this week since I won't be doing any clinic next week and we are only allowed to miss three or four sessions all year. (I want to wait and miss them in May when I am studying for the boards, not in October!)

I wound up working with a resident and his preceptor instead. We saw three patients. One had a sexually transmitted disease, and oh boy, I'm glad that I am not the one who has to break the news to someone that their spouse was probably fooling around on them. Another one had a rheumatological condition, so that was good timing after last week. The resident and I did a neurological and musculoskeletal exam on the patient. We wound up spending a lot of time in the room with that patient, but it was a good learning experience, and I think we really made the patient feel a lot better. Sometimes just having a name for whatever is wrong with you makes it easier for you to bear having a disease, and that was definitely true in this patient's case.

Please Support My Blogger Challenge!

This month, Blogger is partnering with DonorsChoose and asking blog authors to sponsor challenges to raise money for schools. Teachers at schools around the country are able to submit proposals, which are then verified and posted by the DonorsChoose staff. I would like to support two projects that are particularly meaningful to me as a medical student going to a school in an underserved area.

The first project is proposed by a teacher in the South Bronx. She is trying to raise money to buy books for her inner city middle school students to help inspire them to do something big with their lives. The book, which is based on a true story, is called "We Beat the Street." It describes how three boys went from being underprivileged teens to practicing physicians. Even today, there is a shortage of physicians working with minority and low-income populations. Therefore, I am asking my blog readers to please help inspire this teacher's students to think about medicine as a career goal. The total amount of money needed to buy books for all of the students is $536.

The second project is proposed by a science teacher in rural Mississippi. She would like to buy a skeleton model to teach her low income middle school students about human anatomy. She has almost no supplies to use to teach science to her students. I don't know if she will be able to spark an interest in any of them to become future physicians, but I'd like her to at least have the chance to try. She needs $421 to buy the skeleton model.

Thanks so much to those of you who are able to contribute. Even if you can only give a few dollars, every little bit will help. Please click here or on the icon below if you would like to donate to either project in this challenge. To see how much progress has been made toward reaching the total challenge goal of $896 to fund both projects, you can also check out the thermometer in the side bar.

MS Class, Working on My Poster, Finishing Bones, and CCLCM Book Club

Yesterday's clinical trials class was again a review of stuff we had already learned over the summer and last semester. I'm not complaining though--at least one thing in my life is easy! I spent yesterday afternoon working on my poster, and unfortunately my preceptor is making me change things all around yet again. So I'll be doing that this weekend. Thankfully this will have to be the last round of revisions, because I have to turn it in to be printed on Monday.

This morning after PBL, we had two pharm seminars on treatments for rheumatological diseases. To say that the first seminar was poor is about as generous and kind as I can possibly be about it. Maybe that seminar leader was asked at the last minute to replace whoever was supposed to be giving the seminar, because I can't think of any other reason why someone would be that unprepared. The second seminar leader was considerably better. Our POD (oops, I mean ARM) talk today was a basic science one about several proteins involved in the vasculitis immune response. I was initially feeling wary of an entire hour-long talk that was chock-full of pictures of gels and immunoprecipitations, but it actually turned out to be pretty interesting. The speaker had given one of the POD seminars last year too, and this one was completely different.

In the evening, I went to the very first meeting of the new CCLCM Book Club. We had read "Better" by Atul Gawande. I was feeling really tired and cranky, and I almost didn't go. But in the end, I'm glad that I did go, because it was a lot of fun. One of the things that I liked best about it is that we had a mix of first, second, and third years. I had never thought about this, but having people from different classes meet to discuss ethical issues is a really great way to get a lot of different perspectives. I don't think it would work so well for PBL, but it might be useful to have some mixed-class FCM small group discussions.

PBL, Seminar, Physical Diagnosis, and Clinical Correlation

Today was a really long day. I had PBL first in the morning, and we just did not have it together as a group today. The seminar afterward was about vasculitis. I hadn't done any of the textbook reading since it was already pretty late by the time I finally got into my apartment last night. But I still thought the seminar was pretty good. It was about vasculitides, which are inflammatory diseases of blood vessels.

In the afternoon, our physical diagnosis session covered the eye exam. My group had a really great preceptor. We got to use the machine to look at one another's retinas. I forget what it's called, but it's that thing where you rest your forehead against a pad and the optometrist is on the other side moving the lenses around. ("Is it better this way--click--or like this?") I was the first "patient," and the preceptor told all of my classmates to try to see the number on my contact lens. It turns out that they could, and I don't think I've ever had such an intensive eye exam by so many people in a row in my entire life!

After that, we spent two hours meeting with patients who have rheumatological diseases for our Clinical Correlation. (Rheumatological diseases are inflammatory diseases of the muscles and joints.) I wish we would have been given some background about the patients before we went into the rooms, because every single meeting started out with the patient asking us what we wanted to know. To which I always replied, "Um, everything. I don't know a thing about you or what you have." The takeaway points I got from this are that rheumatological treatments are tremendously expensive (most of the patients mentioned this) and that more research needs to be done on how to treat rheumatological diseases (several patients expressed the hope that we would become rheumatology researchers.)

As far as I know, no one in my class wants to become a rheumatologist. I've heard several of my classmates express strongly that they have no desire to study rheumatology, and I feel the same way. But I have never felt so bad about disliking a medical field as I do about this one. Here were these poor patients, all of whom donated their time to meet with us, and all of whom have suffered greatly from truly awful diseases that made them physically deformed, telling us how they hoped we'd find new cures for rheumatological diseases. And there I was, unable to stop thinking about how I am not such a huge fan of rheumatology, and that I will gladly stop studying it the very first second that I possibly can.

On the bright side, I finally found my keys. I have started wearing them around my neck. Let's just hope I don't misplace my neck along with my keys next time!

Innovations, Seminars, and Clinic

For those of you who are applying to CCLCM, yesterday was our first interview day this year. I can't believe that we are already interviewing for the class of 2013! The time really flies.

The theme this week is inflammatory diseases, and our seminar yesterday was about the immune system. It was ok, not the best we've had. After PBL and seminar, I went over to the Intercontinental Hotel for part of the afternoon. Right now there is an Innovations Conference going on there with an exhibition (lots of free stuff) and discussion panels. This year's conference topic is on innovations in cardiovascular medicine. I am trying to figure out why I didn't go to this thing last year, because they let the CCLCM students register for free, and the talk I saw yesterday was pretty good. Larry King was hosting it, and Steve Nissen was one of the panel members.

This morning, we had a great seminar on arthritis, followed by FCM. There was some confusion about where to go, so our small group didn't do much discussion because we were already half an hour into the period by the time our preceptor found us. That was ok with me, because it gave me more time to work on my poster. The same lawyer from last week was talking to us again, and as soon as FCM was over, I rushed back to the Intercontinental to hear Judah Folkman speak. Folkman is involved in angiogenesis research. Angiogenesis is the process by which new blood vessels grow. This is a big deal for people who study tumors because if you could choke off their blood supply, you could kill them.

Unfortunately, he must have cancelled, because he didn't show up. One of my classmates and I were walking around the exhibition, and the super nice lady at the desk gave us each a computer bag. We were going to head back to Lerner for lunch when another lady invited us to eat at the conference. Students weren't supposed to be allowed to eat at the conference because the meals were only for people who paid, but we decided to go up there since we were told it was ok. In the end, we didn't stay though because it was a sit-down lunch and we both had clinic today.

This week's clinic went much more smoothly than last week's, except that my preceptor sprang a surprise observed physical on me. At one point, I blanked out and couldn't remember how to start examining the cranial nerves. It kind of bums me out that even after a full year of clinic experience, I still feel so awkward and slow with the physical exam. My preceptor was really nice about it though and told me that it will take several years to become comfortable with the full exam. I don't think I really had a very good conception of how difficult learning to examine patients would be. It's not even that you have to learn all of the steps, but also that you need to stay in practice. I find that often it is hard for me to remember exams that I've learned a few months ago. When I have some time, I will have to watch the Swartz video again. Maybe this weekend.

On a not-so-good note, I lost my keys somewhere today. I wound up spending an hour waiting for the custodian to come let me into my building--luckily, I have a spare set of keys. But I hope I can find the originals because my favorite memory stick is on the keychain. It got dark while I was waiting outside, and there I was doing tomorrow's reading by street lamp. I got plenty of weird looks from people passing by--what, doesn't everyone read vasculitis articles by streetlight? All I can say is that I'm really glad this happened in October and not February!