What is that big bright thing in the sky?

Oh right, it's the sun! I haven't seen it in a few weeks. We had our last exam for cellular biology and our final biochemistry exam before the NBME this afternoon. Final word count on my notes: 130,000.

It's nice to just be able to take a few hours without thinking about what causes homocysteinuria or Lesch-Nyhan syndrome. Yes, you heard that right. We are, in fact, learning pertinent medicine!

Our last few lectures seemed to flash by. We covered purine and pyrimidine (read as DNA) molecules and the deficiencies associated with them. We learned about cancers and some of the more basic causes. We learned what medicines can treat those cancers and why they can treat them. We learned why acetaminophen and alcohol don't mix in a lecture on xenobiotic metabolism. We covered cellular movement and cytoskeleton formation. We also went over most of the vitamins and minerals, their function, as well as what happens if you don't have enough or too much (things I had no base knowledge in at all).

What else...oh yeah! We got to take a sexual history this last section of class. While it was fun to do in general, it was even more fun when we realized our standardized patient had prepared a list of jokes to make us feel really awkward. It was weird, however, to ask someone as old as your grandparents how their sex life was doing...
Guess it's just part of being a doctor eh?

So we got through our latest and final class exams for this block. No more biochemistry lectures. No more medical cell biology lectures. Does this mean we're done? Not by a long shot my reader(s?)! The shelf exam, the NBME, the National Board of Medical Examiners final for biochemistry is Tuesday. This means that tomorrow morning I dive back into my biochemistry text book. The goal: read it cover to cover in 3 days. Daunting, I know, but I can hopefully get through with 2/3 of it by then.

The exam actually isn't that bad. Its grading scale is based on the national average. Scoring in the 50th percentile on the test nets you an 85% for the exam grade. You quite literally have to score in the bottom 5th percentile in the country to fail the final (not that I hope I get that low).

Do we get a break after the NBME? Not really. We start gross anatomy on Wednesday. That means we start gross lab, the cadaver lab, that evening. I feel like I'll finally be taking a class I have a strong base in. Then again, I thought that about biochemistry, so we'll see about that.

What was my favorite part about this last block of classes? I'd imagine it was the cancer sections. It amazes me the sheer improbability for a single cell to gain/lose all of the functions necessary to make it into the malignant mass that it eventually becomes. The breakthroughs that scientists make every day to combat cancer are also very cool. Maybe I'll be practicing when they come out with the sure fire cure. Wouldn't that be fantastic.

I wouldn't say that it sparked my interest in oncology, but it definitely got me thinking about it. It might be something worth looking into more, but we'll see. Until next time folks, I'm sure I'll have some interesting things to write about this week after cadaver lab.

Good Break Men! Onward!

For the last few weeks, I've been studying the following:

• Glycolysis, glycogenesis, gluconeogenesis, and all of the fun syntheses of sugars (along with around 50 enzymes to memorize using dirty pneumonics)
• The electron transport chain and how the body gets its energy (and why dinitrophenol was bad for everyone!), the pentose phosphate pathway, and beta-oxidation
• Structures and syntheses of lipids, cholesterol, steroids, and hormones
• Membrane receptor pathways for G-proteins, Serine and Tyrosine Kinase receptors, and JAK/STAT receptors (and all of the less famous receptors - my favorite being the Hedgehog receptor)
• Population genetics (which turns out to be quite similar to racial profiling...go figure), genetic screenings, and pedigree analysis
• Somewhere between thirty and fifty diseases and disorders that are associated with defective enzymes in any of the above subjects. This part was particularly cool, since it actually felt clinically relevant; we felt like we were in medical school rather than in some PhD class.

I spent the entire last two weeks studying for the exam that we had on Friday. I imagine that the exam went fairly well, but I won't know officially if my zealous study habits payed off until sometime today or Tuesday. One thing that did come of the Friday exam was...free time!

For the first time in some five weeks I actually had a full two days off with no obligations, no attachments, and nothing at all to study! Good times were had.

Everything important that needed to be done got finished. Grocery shopping? Check! Laundry done...almost! Cleaned my kitchen? Maybe next free weekend... And cleaning up my room? Eh, it's not too dirty for now.

So what did I do? My long time girlfriend came up for the weekend to spend some quality time. We climbed the highest mountain within fifteen miles of here (gas is expensive), ate at some local restaurants, and genuinely enjoyed the free time we had together.

Tomorrow I go back to the grind. We start on microtubules and actin/myosin filament structures and I know that'll have me on the edge of my seat. With a whole weekend of rest and relaxation, I feel like I can take on medical school once again. Bring it on!

Just...a bit...more

Busy Busy Busy!
The first test was there and gone last week. The class actually did pretty well as a whole. The average for the test was 80%, and I was happy with the score I received.

There is no rest for the wary, though. We had a quiz the next day. A quiz that Thursday. A take home quiz Saturday. Another quiz Monday. It really does take away from the time I have to do my little hobbies. Don't get me wrong, I spend the first hour or so when I get home lounging around watching brain dead videos of cats killing balloons, but med school overall keeps me pretty busy.

This, then, is the reason I haven't written in a week or more. I'll try to be better at it when I can, but bare with me if you don't hear anything for a small amount of time. I just have to wait for that lull in studies to give me time to write.

Phew, now that that's all out of the way (and I still feel like procrastinating from studying), it's time to bring an update to my week!

The class got to interview new patients this week. This week we conducted the History of Present Illness. Based on what the standardized patients presented with, we got to narrow down our diagnoses and take a mock history of their symptoms. It was kinda cool! It seems like everyone (including myself) are getting better at talking in a doctor patient setting.

We went through glycolysis, gluconeogenesis, the citric acid cycle, oxidative phosphorylation, glycogenesis, glycogenolysis, phospholipase synthesis and degredation, and hormonal control of metabolism all in the range of a few days. I'm not sure if I'm crazy, but after going over all of the information for so long, the following statement actually makes sense:

Protein Kinase A phosphorylates phosphorylase kinase to phosphorylate glycogen phosphorylase to phosphorylate glycogen into glucose-1-phosphate.

I've swear I've started spouting names of enzymes in my sleep, but that's probably normal...

Alright, time's up. Back to studying for me!

Sure, I can answer a few questions!

No, the title doesn't make much sense, but I have an excuse. Today was an important milestone in my medical school career: the first exam. After studying for roughly 38 of the weekend's 65 hours (and spending 5 hours watching the League of Legends championships), my brain resembles some slightly overcooked oatmeal. On a more exciting note, though, I got to interview my first standardized patient today! But more on that later.

I thought it would be a good idea to wake up an hour early this morning to ensure that I got to school before the exam began. It was probably a good idea since three or four drivers thought it would be a good idea to get into a few fender benders on the highway. Thinking ahead triumphs again! The test itself wasn't that bad. I felt like I knew a decent amount of the 140 questions on the exam and, while I'm sure I'm not going to stand up and take a bow as the only 100% in the class, I can cross my fingers and hope for a solid B.

After the exam, we were given an hour break before we dove into the next lecture (welcome to medical school ladies and gentlemen). The ICM lecture today introduced us to, as our professor put it, the most important diagnostic tool in any doctor's arsenal: taking the social history. We went over how to take a history and how to ask more personal and embarrassing questions.

I'm not going to be able to talk much about the standardized patient that I had the privilege of interviewing. The medical field frowns on confidentiality breaches, even for fake patients. I can, say though, that it was a blast, and getting to show up in a that white coat and a stethoscope definitely makes you stand up a bit straighter.

Med school is probably one of the toughest things I've done so far, and it's not over yet! Tomorrow, I have a quiz on last week's Problem Based Learning (PBL) lectures. My oatmeal brain got to rest for a few hours, but I need to use it again. It's almost as good as new, I promise.

And I didn't even get any popcorn!

Today we were able to watch a movie for our Introduction to Clinical Medicine (ICM) lecture. The movie, appropriately titled The Doctor, was there to show us great examples of how and how not to care for your patients and touched on points in professionalism and compassion. Now, I'm not complaining that we were able to attend two hours of lecture time watching movies. My brain welcomed the break and I enjoyed the added free time in my evening, if you couldn't tell. I spent the majority of my prized free time bowling with friends (and I bowled a gentleman's 114 if you were curious).

While watching the movie, though, I did some calculations and found out that I spend (as an out of state student) nearly $40 an hour for medical school. That movie ticket cost $80, and I didn't even get any popcorn!

Great day today!

No time to post? Nonsense!

Before I begin this post in seriousness, I want to point out something that I've found out already. Medical school is fun. You meet all kinds of people. Your professors (can be) very entertaining and highly motivational.

In our first Introduction to Clinical Medicine earlier this week, our professor went through the basics of exams and bedside manner. He went through how to get a patient comfortable with you touching them and how to get the patient to trust you enough to for them to actually listen to what you have to say. In a few weeks, we'll be able to examine our own patients, take their histories, and listen to their heart and lungs. We'll get to where our white coats with the stethoscope around our necks and actually do what doctors do, which feels really cool. We have to learn a lot of textbook information each week (mounds of buzzwords, slides, graphs, and studies), which isn't fun, but being able to go hands-on with patients, that is.

Okay, now on to the show!

~~

This is really my first big break since the beginning of the week. One thing I've really come to find out from medical school is that it is a lot of work. And I hear the readers that are in or have already gone through medical school all yelling a resounding and simultaneous, "Duh," it really came as a surprise to me.

Lets put this into perspective by giving you a glimps into my day tomorrow:

• 7AM: Wake up (read as try to wake up and press the snooze alarm)
• 7:30AM: Really wake up
• 8AM: Make coffee and head out the door by 8:15AM
• 9AM: PBL Lecture - Failure to thrive
• PBLs are in class discussions where they bring a case forward that we evaluate. It helps to teach us the steps in diagnosis and the importance of research in medicine
• 10AM: Stem cells and Lineages
• 70 slides
• 11AM: pH, Amino acids, and Peptides
• 40 slides
• 12PM: Food time! My favorite time of the day
• 1PM: Protein structure
• 40 slides
• 2PM: Principles of differentiation
• 120 slides (Just kidding, it's only 80)
• 3PM: Head to the gym for some non-medical "me time"
• 4PM: Head home and start organizing my notes
• The professors go so fast when the lecture, easily going faster than a slide every 30 seconds, and my notes start entering a realm of incoherence around that time
• 5PM: Find some dinner around the house
• 6PM: Start reading through the books to grasp key concepts I might have missed
• Four to five lectures a day means four or five full sections in a textbook
• 7PM: Start relating my notes to the powerpoint slides. 
• 11PM: Catch half an hour of random television
• My mind needs some numb time at this point
• 12PM Head off to bed

All in all, expect to spend an hour of time at home studying for each hour in class. It's not something that you can get around. Gone are the days when I had freetime I guess, but I signed up for it!

I've learned so much and classes haven't even begun!

Okay. We hit the ground running in medical school tomorrow. We've been given our first few weeks' schedules and, if you're curious, you can look at it here. As you can see, they throw a lot at you immediately (and I'm pretty sure I've heard the phrase "drinking from a fire hose" no less than ten times in the last week). It's obvious that we have a lot to learn in a very short amount of time, but I wanted to take the time before classes actually start to list down some of the things I've learned up until this point. For the sake of my own amusement, I'm going to list them in my mind's order of importance (including everything from medical school apps to med-school itself).

• If you think that you won't fit in with the other students during medical school, you're dead wrong. The demographics of medical school are nearly identical to your undergrad years. The IQ bell-curve might have moved up a few inches and there are definitely more Type-A personalities, but you still have those goofy awkward kids, the frat stars, the computer geeks, the jocks, runners, and triathletes, and everything in between. On top of that, every single person in the class is working their butt off in medicine, which means you all have something in common. You'll fit right in, I promise!

• Arkansas frogs pee on you when you try to pick them up.

• Live close to school, like...really close if you can find a safe neighborhood. I live about seven or eight miles from campus and it seems like 90% of the rest of my classmates live within two miles. If you live close, you can walk or bike to class if you want. All of the social gatherings (read as parties and dinners) are usually close to campus. Living close is convenient and keeps you close to your social peers.

• Don't spare any expense when you are applying to medical school. If you have the funds available, don't second guess whether you should spend that money on a new suit or that new pair of shoes. Don't wonder if you should have your personal statement professionally critiqued, just do it. I used Atrium Learning and they were superb. They helped me with my statement from the time I wrote it to the day I turned it in. When my finished product was 800 words too long, they cut it down to size and they did an awesome job. It was $140 if I remember correctly, which really is chump change when you realize you'll be in debt about $200,000 by the time everything is said and done. Pull out all the stops, you only get one (or possibly a second) chance to get into any medical school and you don't want to blow it because you didn't spend a bit extra to make yourself look all shiny and new.

• As an adendum to the above, be careful about having someone write your entire Personal Statement. As taken from the AMCAS site directly: "You can’t have your university writing center, your parent, your professor, your friend, or a professional editing service compose your documents. The difference between “editing” and “ghost writing” is obviously a grey area, and applicants must be careful when seeking out help on their documents."

• Medical school is expensive. Between moving, buying books and equipment, and signing up for classes, I realize why I need that huge loan. I feel like I'm already broke and I haven't even gotten my loans yet.

• Be aware that you are going to spend an exorbitant amount of time studying both at home and out. This isn't like undergrad, where they tell you you're going to spend two hours of studying for every hour in class and you quietly snicker and go, "Yeah, that'll happen." We have anywhere from three to five lectures per day. We do an entire Biochemistry class (a full semester in undergraduate) in 9 weeks while we do a full Genetics and a full Cellular and Molecular Biology class at the same time. If you get behind by a day, that's roughly 4 hours of studying you'll have to catch up with by the next day. If you don't keep up, you're going to get buried. It's as simple as that.

• That being said, there are a large group of students that attend less than half of the classes in any given block. There are tons and tons of resources out there to get the information. Our class will appoint note czars to publish their notes every day for the rest of the class. Most of our lectures are podcast so that we can listen in outside of class (or catch up if we miss a day). We have textbooks and rapid review books, flashcards and quick notes. With so many ways to learn, you can pick your own style. If you don't learn well from lectures, read the books, the notes, and the powerpoints. You won't be much worse for wear. Again though, don't fall behind!

• Regardless of how independent you seem, you really need some support. If you have family and friends close by, use them. Now I'm not talking about emotional support (although that is part of it). Sometimes you just need a warm meal, a game of golf, or a day of fishing to get your mind off of medical school. Use the people you know to help get your mind off of the 300 pages of biochemistry that you've been leaning over for the last six hours.

There are a ton of other things to post: 

• Only apply if you are dedicated
• We are entering a very rewarding profession
• We have to hold up to certain standards
• Etc, Etc

All of these (and everything else that's escaped my mind today) most of us already know. If you have any real questions, just send me an email or post below and I'll try to answer when I have a free moment. Until the next post!