So, as promised, I’m going to let you all in on the wonder that is the forearm and hand of the human body. I came in to the lab on Monday (otherwise known as the Very Long Day) after a full three hours of anatomy lecture in the morning and proceeded to start working on Beatrice. It’s pretty incredible how many small muscles there are - multiple layers on each side all give off thin, strong tendons that make their way all the way up to your fingers. Pulling on certain muscles then allows you to see the fingers flex slightly in a sort of disturbing puppet way. All the while being entirely respectful to the cadaver of course.

Anyways, while this part was a lot of fun, getting there was no easy task. My team was stuck doing the skinning (yes that’s the best and most accurate word there is…) once again and I found myself hunched over Beatrice’s hand for the better part of two hours. The arm, not so bad, but the hand and especially the palm were incredibly tough to get skin off of. All this makes a lot of sense once you realize that a lot of the hand is very tough, very thick ligaments that provide the cushioning that you need in your day to day life.

Still, it sucked.

Back to the anatomy! Now that we have dissected the entire upper arm, it’s amazing to trace out nerves and arteries all the way from the clavicle down to the hand. The excitement is lessened slightly as I realize that I have to memorize everything that I see, but being able to pull on a nerve by the biceps and see it move down near the wrist is pretty damn cool. With all of this comes a price however, as the hand can be very disturbing for some people to dissect. The hand is something that we connect so much with being human that it can be difficult to distance yourself from what you’re actually doing. In fact, one of my table partners had to leave during the skinning of the hand as she broke down crying.

It’s tough, but it really put into perspective what it’s like to be a physician - you have to distance yourself from your patients or your emotions can overtake you and affect your judgment and decisions, but you still have to connect with them somehow to help improve their visit and their impression of you. Having a patient feel like they made an impact on you (whether real or imagined) is just as important as getting them the right treatment. You have to be actively involved in every case that comes under your scrutiny, because if the patient sees you involved, they will put more of their trust in you, the community leader.

In other news, we had a meeting today about our medical equipment and the options that we have in upgrading certain items. As part of going to BU, we get a very nice stethoscope, opthalmoscope, otoscope, blood pressure kit and cuffs, reflex hammer, and two tuning forks. Now this is incredibly exciting because this equipment will theoretically last me for the rest of my life and is yet another marker of becoming a physician. Today was just letting us know that we have the option to upgrade some pieces - something I’m not really going to do because I probably won’t be going into primary care and won’t need them on a day-to-day basis. The standard equipment is going to work out just fine for me. My dilemma though is in the choice of a color for my stethoscope tubing. I know, I know, it sound ridiculous, but again, this is something I’ll always have and use just about every day. Right now I’m stuck between the standard black, a nice hunter green, and a burgundy that is a bit brighter red than it sounds. Black is always good, but I wanted a color to just be a little bit different and the green stood out. My problem, nay, my conundrum, is that once I start doing my rotations, I’ll have a giant red patch with the BU seal on it as well as my red name tag on the coat. Can I deal with looking kind of christmas-y for two years? I’m not sure I can…

Help me out people! If I can figure out how to add a poll to this blog I will, but for now, put your thoughts in the comments!

Now, off to more anatomy!

I’m so happy
Cause today I found my friends
They’re in my head

So loyal readers, you find me once again on a Saturday night, buried up to my shoulders in books and diagrams. It actually looks like the room belongs to an autistic savant - books in piles strewn haphazardly over the bed, and one particular drawing scrawled over and over on multiple sheets of paper litter every free space.

Ah, the life of a med student on a typical weekend night.

A few of you might be wondering what I’m doing inside on such a wonderful evening, having just finished a biochemistry exam on Friday, and seemingly nothing to do. Well my friends, that test kept me from the anatomy that I needed to study, and with the brachial plexus (more to come on that in a bit) foremost on my list of things to learn, I needed to get down and dirty with those little things that let us all move our arms. You see, anatomy is much like time - seemingly incomprehensible without a vast knowledge reserve, and it also “waits on no one.” The B group at Beatrice dissected the brachial plexus, arm, and cubital fossa this past Wednesday, and it’s time for me to catch up on what I didn’t see. Oh, by the way, the arm is technically only your upper arm, the forearm is the other part.

For those of you not TWG (who has heard way more than she wants to about this) the brachial plexus is a bundle of nerves that intertwines and makes its way to your arm, allowing you to move every one of the 88 muscles in your arm as well as about 16 more that make up the movers of your shoulder. I need to know the diagram of these nerves and the innervations that they make on those muscles. For a little taste of med school, see the diagram below for clarification on what I mean.

hmm, I can’t seem to upload the picture that I want to, and all it tells me is that it can’t do it…odd

Well, I guess you’ll just have to settle for the Wikipedia article, which I’m much less impressed with. Don’t worry loyal readers, I’ll do my best to get this image uploaded somehow, it’s too nice to not show you.

In semi-related news, I’ve now received multiple requests to be a bit more “detailed” shall we say, with my descriptions of what I do in the anatomy lab. So, in order to bow to the wishes of my tiny public, I’ll incorporate a bit more starting this week. It should be fun - Monday sees me in the lab working on the hand and wrist, which should be a bit less disturbing than some of what I have done in the past few labs.

Unfortunately, those piles of diagrams are begging for me to draw the BP just one more time and the siren song of Netter’s Anatomy is pulling my hands and eyes back to its colorful pages. Until next time, my pseudo med students!

I’m going out of my head,
I feel like I’m dead,
I’m feeling Lo-fi

AH HA!

Finally an explanation!

(TWG, despite the article above, I still miss your blanket stealing when you’re here with me)

I used to rule the world
Seas would rise when I gave the word
Now in the morning I sweep alone
Sweep the streets I used to own

I know, I know - cheesy title, but it seems to work for me. As you might be able to tell, today found me dressed in blue and standing over Beatrice for the entire afternoon. The lab was about the glenohumeral joint and pectoral region (shoulder and chest for all of you too lazy to go to Google) and Beatrice once again proved to be just a little more interesting than expected. Nerves and arteries were not quite where we expected them to be, and some other defects made identification of structures more challenging than it might have been otherwise.

Also, fun fact for all of you - identification is just about completely dependent on how something feels. This is not more apparent than when your face is inches away from a mass of structures you can only assume are nerves, veins, and arteries. Those all tend to run together, and separating them out to name them can be quite a challenge. However, all of your troubles - well at least most of them, you still have to find the damn things - are solved if you just feel the thing in question. Does it feel flat and roll easily? Does it bounce back to a round tube? Does it feel grainy when you rub it between your fingers? (Hint: Vein, Artery, Nerve)

Either way, it all adds up to a very long day. Three solid hours of Anatomy lecture in the morning, 20 minutes for lunch, and Lab straight through until 4:30 or so. I’m tired, and my brain is very very full, so please excuse any incoherence in this post.

In non-crazy-med-school-world, my shirt from Threadless arrived today (yay!) meaning that tomorrow I can get a whole lot of weird looks from my classmates. Not much else to update you all on for now, as this week will be a lot of studying broken up by TWG coming in for two days (YAY!). In other words, don’t really expect another post from me unless it’s Thursday night before my exam and I ned to put off studying for a bit.

Enjoy the week!

Clean shirt, new shoes
And I don’t know where I am going to.
Silk suit, black tie,
I don’t need a reason why.

As you might as well have guessed from the title of this post, yesterday was our first dissection in Anatomy, and Beatrice proved to be both a boon and a bitchy old lady. I mean that in the nicest way of course out of respect for the dead. As I mentioned before, she was pretty small, so there isn’t much fat on her, which makes for part of the dissection to go a bit easier, but other factors came up during our exploration. It turns out that Beatrice was bedridden for quite a while before she passed away, and her caregiver was not very good at getting her out of bed. Yep, that means bedsores, and large ones. For those of you who have heard about them (and the reason why everyone must at least roll around or get up when in bed for a long time) you might think that they’re not that bad.

Beatrice would prove you wrong in a heartbeat.

These sores were really bad, making the underlying skin very tough and hard to get through. Oh, and if I’m grossing any of you out, now might be a good time to stop reading. Besides this slight problem, she has probably been dead for quite a while. You see, the cadavers in the lab are not all “fresh” as Zach might say - they have been dead for varying amounts of time up to about nine months I think. Some of the more recently deceased are still very red on the inside (makes those groups think a bit more about eating roast beef for a while…) but Beatrice’s muscles were very gray. This isn’t really a problem, per se, but it makes identifying and cleaning off the muscles that much harder.

Speaking of the process of dissecting, I had so much fun! It’s a lot harder than you would think to make it look really nice, and I’m actually going in tomorrow on my own time with my group to try and clean it up so it looks all pretty. Otherwise, I won’t bore you or completely gross all of you out by going into any more detail, but I had a great time and I can’t wait to get back in there. On the flip side, I now have a lot of work to do - it’s one thing to memorize names and placement from pretty pictures in books, and quite another to try and find the damn tiny nerve bundles that look exactly like fat tissue as you dissect. It’s as if, to dissect well, you already have to be an expert in the anatomy to get your cadaver to look like it should. In order to be an expert, you have to dissect and be aware of what structures are where and what they look like. This, as you can tell, is a circle that does not work out well for the first-time dissector. Oh well, time to go in tomorrow and spend a few hours working very slowly on it.

(No song lyrics this post, because I’m listening to Spanish guitar)

Yay! After a long wait, Threadless has FINALLY reprinted the shirt that I have been looking at for years now. You have to understand, this shirt is so perfectly “me” that when I first saw it I was drawn to it and had to buy it. Unfortunately, being the broke college kid that I was at the time, I didn’t fell like I had enough money to justify it. Lo and behold, a week or two later when I decided that I really couldn’t just stand there and let it taunt me, I went to the site and found it had been sold out!

Just my luck right?

Well, thankfully, Threadless has a nice little link on each page of a particular shirt that says “Notify me if this becomes available again.” This is because these designs (who are created by normal people like you and me, with more artistic talent) run out of stock fairly quickly. Well, I clicked the link, put in my e-mail address and waited patiently. I also kept the bookmark on the side of my browser to check on it just in case I didn’t get an e-mail. After over two years of waiting though, I just didn’t believe that I would ever see it reprinted, and I finally gave up a few months ago and removed the link on my left side.

Enter the e-mail from Threadless.

I usually just delete the e-mails from these people as they usually don’t matter to me (especially now that their prices have gone way up over the last year or so), but today, it began with the word Reprint! Curiosity piqued, I opened it up to find that my beloved shirt was being reprinted! And in light blue no less! (Columbia pride still has a big place in my heart)

A quick grab at my wallet, and two minutes later I paid for a shirt when I still haven’t paid my rent for this month - something I hope to do soon without anyone getting angry at me…

I wanna break every clock
The hands of time could never move again
We could stay in this moment
For the rest of our lives

Ah, September, how wonderful you are, beginning with a day off for everyone. Beaches and barbecues mark the last vestiges of a summer that has been one of the nicest in my recent memory, especially here in Boston. Oh September, you go on to promise apple season, with field trips to go act like the owner of an orchard, picking globes of all colors that have never seen a waxy coating or the inside of a truck. Apple pie and fresh cider will soon grace the inside of my fridge, and the leaves will change into hues of brilliant red and shining gold.

I think that’s enough of the waxing poetic - don’t you? In all reality, I really enjoy the beginning of fall, when the temperature begins to drop just a bit and the season starts to change. Unfortunately, to all of you who are still in school of some sort, September marks the beginning of another year of drudgery. Either your classes will be starting soon, or they have already begun and you’re just starting to feel the crunch. The latter is what’s going on with me - classes will start to accelerate this month, becoming paced full of biochemistry and anatomy all day long, with patient interviewing every week. Information will be given to me in such a volume, that our teachers love to use the analogy, “drinking from a fire hose and not letting a single drop fall down your chin.”

What an image.

In other, more relaxing news, in my quest to stave off the boredom that comes from studying all the time, I started watching shows on Hulu. I certainly hope that the website is nothing new to you, my faithful readers. It’s essentially a place where you can legally watch a lot of the TV shows that you might be looking for in other, less scrupulous ways. Sure there are a few short (<15 sec) commercials interspersed, but it's totally worth it for the great quality of the video. Anyways, I've started watching Bones, a great crime/CSI-ish drama, only better. I think what I really like about it is the fact that not only is the science fun, but the characters have a huge amount of depth and range. Each episode reveals a bit more about each person, allowing you to build up a picture of who they are and what they are like underneath the surface. Check it out, it’s a lot of fun, and you just might find yourself sucked in before you know it.

There’s too many ways, too many ways, I could spend hours in my day

So I’ve returned from the haven that is NYC with exciting news and fun stories!

First off, New York was a great trip as always - TWG is doing very well and we got a lot of time to just walk around together and spend time with each other. In between errands, we got down to the Green Market in Union Square which was something I have never done before. It was so much fun to see all the fresh produce that gets brought into the City, and pushing through the crowded stalls made me reminisce about Morocco and what it was like there. It’s odd to think that, even if it’s just some small way, life hasn’t really changed from long ago when you would go out to get your fresh vegetables and fruit daily.

The two of us also picked up a bottle of wine from a vineyard in the finger lakes (sorry I don’t have the name with me right now! Ask TWG?). I love the region there, and I highly recommend that everyone take at least a day to go up there and just explore the wineries. They often give great tours, and the wine is quite good - much better than you would expect.

In the exciting news / fun stories category, I started my Anatomy course yesterday for real with a lecture about the vertebrae and the major muscles of the back. For those of you that don’t really understand how intense med school can be, this is a good example: I need to end up knowing the name of every muscle in the body, where it attaches, what its action is, and what nerve innervates it. I also need to know the names and functions of all the ligaments (did you know that there are an incredible amount just to help the spine?) as well as the major arteries and venous drainage systems. For the bones, I’ll need to know the name of every bone in the body, all 206 of them, plus each bone has an average of 6 features that I need to memorize the names and functions of. By the way, these “little features” are not usually more than small ridges that all have to be categorically tagged and identified.

Fun.

Anyways, I got to meet my cadaver and my dissection group, which was awesome! We named ours Beatrice after the B that started out her coded identification tag - we’re not allowed to know the real names or identities of the people we dissect. Beatrice is a great cadaver; she was a skinny little old lady and the lack of a large amount of adipose tissue will make her a lot easier to work with. Other groups around me were not so lucky, getting women and men who were morbidly obese or overweight, making their work harder. We didn’t really do much with Beatrice besides some surface anatomy work, but I can tell you, it was weird as hell to take her head in my hands and lift it up so we could wrap a cloth around her face. You can prepare yourself all you want, but the first time you lay hands on a cadaver, it’s hard to shake a feeling of “wrong” or “odd” that overcomes you. I’m so excited about the prospect of working on her, but it still unsettles me a bit when I go to see her. We’ll see what happens when I make my first incision in a week.

Nothing too much else to report, except for a bit of music that you might all want to check out. First of all, Ruckus is my friend, and I found Sherwood and The Send

Go check out their music and let me know what you think!

Oh, I could never have
What I need without you
Oh, I could never know
Who I really am without you

Well, I wasn’t planning on updating until I got back from NYC, but I just HAD to show you all this:

EA responds

The first bit is what some guy thought was a bug in the new Tiger Woods game for Wii. EA responded in one of the most hilarious ways I’ve ever seen by making the above video and distributing it.

Please, please, click on it and enjoy.

You got to take this one day at a time

Ah, the easiest way to get college and grad students to do something - give away free stuff. Whether pizza, T-shirts, or pens, we’re totally there and we’re taking as much as we freaking can.

What prompted this all-so-obvious revelation? Today we had the student organization fair after our daily dose of biochemistry and EPH (Essentials of Public Health) and there was free stuff galore. Candy sparkled in cellophane wrappers at every table, but the best stuff was a small preview of what it’s like to be a physician. The table from the Mass Medical Society has free clipboards and pens, while the Alumni Office was giving out really nice travel mugs. My female colleagues ended up with tote bags courtesy of the Women in Medicine group, and more than a few people has other random gifts that just didn’t interest me enough to take. Free stuff rocks my socks off.

On the other hand, this is really a small preview of what we’re going to experience after we graduate medical school - pharm reps love to give free gifts to doctors. Pens, pads of sticky notes, and expensive dinners are just a few of the things that I’ve seen over the years being the son of two physicians.

My favorite by the way was a pen from Viagra that at first glance looked to be about half the size it should be, but when a button was pressed, it unfolded at one end very slowly and VERY suggestively.

But I digress. Is it right that physicians are courted by these pharm reps like suitors after a lover? People tend to have varying opinions about how ethical it is to receive gifts from a company that is in essence, trying to influence you to prescribe their product over a competitors. Also, if your patients see that everything you carry in your pockets and strewn across your desk is done up like a NASCAR car, they might be influenced into pressing you a bit harder for some name brand medication. Personally, I think it’s fine for the reps to come and give small gifts - as a physician I am going to make my choices based on what I think is best, even if the possibility exists that I will be subtly influenced by the pad of paper that I write my grocery list on. Still, it might be nice to see a reduction of the perks that these reps offer and have the money go back into research, but that’s a whole other post/rant.

I’m going down to NYC on Friday to visit TWG (who just signed a lease on a great new apartment - congratulate her!) so I’ll be away from Boston for a little while. My first Anatomy dissection is coming up on Monday, so be sure to check back next week for what I have to say about that. I can’t wait!

Terrifying best, days of our lives
We’re hanging on the best days of our lives
Today’s about the best days of our lives