Happiness!

I passed anatomy.

On Sinuses

In our head and neck section, we learned about sinuses. As you know, those are the things that get clogged when you're sick, but I'd never figured out what they were until now. It turns out that they're mucosa lined cavities which are carved out of skull bones during development for the sole purpose of getting congested during illness. Just kidding. Their purpose is debatable, but the most reasonable one I heard was that they function to make the skull lighter.

One sinus is particularly interesting because it lies between the nasal cavity and the brain, specifically the pituitary gland. Some brain surgery is now done through this sinus. It's called the sphenoidal sinus. What happens is that they stick these really long laproscopic tools up the patient's nose, punch through the floor of the sinus at the top of the nasal cavity, then punch through the roof, and voila! they're in the brain right where the pituitary gland sits. This technique is nice because is minimally invasive, and patients recover much better.

One of the tools they stick up the patient's nose is a camera, so we had the opportunity to watch clips from one of these surgeries. The clip I really want to tell you about is the one where they repair the holes they poked in the beginning. They gather up little bits of bone and mucous and such and pack the hole they've made. To hold it all in place, they'll also use some biologically resorbable material. One of the things they pack up the hole with is fat. Yes, the patient's own fat. They harvest it from elsewhere on the patient and start sticking it up their nose. We watched little pincers holding a string of fat go all the way up the nostril, drop off the fat, pack it down, go all the way back down the nostril, pick up more fat, and then repeat. It was rather surreal, because you start with something familiar and normal, and then it rapidly turns into something that you never expected to see happen to a nose. There's a nose, an ordinary nose, but then all of a sudden, you see these pincers holding a yellow gob of fat. And not only that, those pincers are actually traveling up the nose, and for some reason, you're going with them. All of a sudden, you're not looking at someone's nose anymore, which is a perfectly normal thing to do, but you're actually hanging out inside their nose with some fat from their belly, which is not a very normal thing to do.

So, before I go, one last note on sinuses. You know when you get sick there's one particular pair of sinuses that feels particularly congested and horrible? It's the pair right under your cheek bones right? Those sinuses are called the maxillary sinus. The problem with those sinuses is that the hole they drain through is relatively high up. Imagine something like a teapot, where is spout is high, so it actually needs to be tipped over in order to drain. Now, there are cells in the sinus that sweep mucous up towards the opening, and this is all well and good when you're not sick, but when you're sick and there's tons of mucous, they're overwhelmed, and you end up with a congested sinus. So, based on where the hole is for drainage, one thing you might try when this happens is tipping your head over. That might help. Let me know how it goes.^^

Blini

Dinner last night was the first time I've ever been to a Russian restaurant. We went to Russian Teatime. I had pancakes, technically blini. They ranked high on the yummy scale. I wish I had a picture to post, but as I just moved, my camera is still packed away, and I'm really leery of unpacking more than I have to, since I'll be moving again shortly.

Since there's no picture, an explanation will have to suffice. Blini bear only a passing resemblance to American pancakes. They're round, flat, starchy, and pan fried. Beyond that the resemblance ends.

A taste comparison: According to my source of information on Russian food, blini involve a cultured component which gives them a bit of a tang. Since they're leavened, they don't have the funny baking powder aftertaste that American pancakes sometimes have, and they're a lot less sweet, both qualities that I appreciate. The sweetness also has a bit more depth, since they are leavened.

A texture comparison: Somehow, and I honestly have no idea about why or how this happens, they're actually kind of custardy on the inside. American pancakes get their air from baking powder and baking soda, so they're light, fluffy, and bubbly in texture, but blini are stretchy and smooth and creamy. And again, I have no idea how, but in the process of frying, they acquire actual crispiness on the outside, which American pancakes lack, at least in my experience.

Does this explanation do the blini justice? Do they sound appetizing? I'm not sure how successful my description was, but I like them a lot, and hopefully I'll learn to make them myself.

They were served in the restaurant with sour cream and raspberry sauce. I've never had sour cream on a pancake, but it was a brilliant idea. It was sweet, but with a lot of depth. Sophisticated sweet. I believe that you can also serve them with caviar or smoked fish for traditional savory versions. They're quite versatile, so you can probably serve them with anything your heart desires for an infinite number of non-traditional versions.

And lastly, in my ode to the blini, my intent is not at all to disparage American pancakes. They have their time and place as well, and all breakfast foods have a special place in my heart and stomach.

Quote of the day:

"Beginning in the left upper quadrant, pass the jejunum and ilium between your hands and appreciate its length, position, and termination."

-Grant's Dissector

All I can say is: ewwwwwwww.

We've finished the abdominal dissection, and it's my least favorite dissection so far. It's gross, things are not nicely arranged, there's a lot of variable anatomy, and well, it's gross. And not only is it gross, the smell reminds me of seaweed, which is a food I enjoy, and the gallbladder leaked, so half the intestines are green, and there's this frothy bubbly stuff floating around from melted fat. All in all, it sort of looks like a totally revolting little ocean in there. The only thing it has going for it is color. It's definitely the most colorful dissection we've done so far what with the yellow fat, green bile and red coagulated blood against the the general greyish and whitish rest of the body.

We did see some interesting x-rays today, though. There was someone who had a Sky vodka bottle lost in their guts. That must have been really painful beause those bottles are enormous. It took up so much of the abdomen. And I really wish I knew what kind of explanation the patient gave for that.

Some Haikus AND the Dance of Many Cloths

This is a bonus double post since I haven't posted in so long.

Anatomy lab.

Question: S'pose we need this thing?

Likely not. Whack. Oops.

Invisible lines,

Black on black and white on white,

Radiology.

The Dance of Many Cloths is not as romantic as one might guess from the name I've given it. It involves many props:

1. A balloon with some tubing, two strands of red yarn, a strand of yellow yarn, a strand of green yarn, and a strand of blue yarn attached. This will represent a testicle and all the vessels and nerves trailing along with it. There is the vas defrens which is the tubing. It has its own dedicated artery, which is represented by one strand of red yarn. The second strand of red yarn is the artery for the testicle. The yellow is nerve, green is lymphatics, blue is vein. So this should be a sign. If you don't want to read about testicles, you should stop reading now.
2. A sheer, gauzy white cloth. This is the transversalis fascia.
3. Three striped clothes. These will represent the tranversus abdominis muscle and the external and internal oblique muscles. The stripes indicate the directionality of the muscle fibers. Transversus abdominis and internal oblique fibers run in the same direction, and both are perpendicular to the external obliqe.
4. A fleshy colored cloth somehow formed into a sac. This is the scrotum.
5. 6 people. One person per prop.

And now to setup for the dance. One person holds the testicle aloft. He or she will stand in the back because the testicle develops prety much right up against the back in the area where the heart is (actually, the ovary does this too). One person holds up the transversalis fascia. This is the layer of connective tissue between the abdominal wall and all the guts inside. The muscles will be held up in this order from back to front: transversus abdominis, internal oblique, external obliqe. Transversus abdominis needs to be held slightly higher than the others. The fibers of external oblique point down and towards the middle. Lastly, someone will hold the scrotum.

After all the setup, the dance is actually quite brief. The testicle, plus its associated dancer, moves forwards. As it does, it acquires a covering of everything except for the transversus abdominis, which it passes under. After acquiring all these layers, it then is dropped into the scrotum. And so here we have it, the Dance of Many Cloths, and interpretation of the descent of a testicle.

Quote of the day:

"Did you guys eat lunch?"

The rest of the medical school class has joined us MSTPs in anatomy lab. We've completed dissections of the arms, legs, and back in the three or so weeks we've been there. After seeing how dissected The Body was, someone asked, "Did you guys eat lunch?" I laughed pretty hard. We've done about 40 hours of dissection on our body. If only we could have done it over lunch. Sighs. Only one and a half months of anatomy left to go.

It's not actually that I dislike it. It's just such an inconvenience. You smell repulsive until you shower. You have to change in a locker room with a bunch of other people at least twice a day. Things get gross and you want to prevent as much cross-contamination as you possibly can between the stuff that goes into lab and the stuff that doesn't. And it just takes such a long time. If I felt more free then it would probably be better, but as it stands, I'm trying to make living arrangements, I still need to clean, do laundry, cook, and run errands. It's been two months since I moved here and only this week did the mailbox get fixed.

So, I'm not sure when this turned from a post about anatomy to a rant about all the things I need to do, but in conclusion, there's such cool stuff in anatomy, but I just feel too busy to enjoy it properly.

Oh, and dissection is much better than the week of looking at embryology cross-section slides on the computer that we just finished.

Overly Poked

Today we learned how to give each other injections! I am now richer by 1mL of saline solution and three extra holes in my body.

We did intramuscular injections and subcutaneous injection. I hate being poked with needles. My heart rate goes up, I get nervous, and I might actually breath a little fast, but it's never as bad as I'm expecting it to be. Perhaps it's good that my expectations are always so low. It hurts, but not terribly. I think menstrual cramping is worse. It's just that this is a voluntarily accepted pain and it's a foreign, pointy, scary-looking object piercing your skin.

The intramuscular injection needle was LONG. Maybe two inches? Because I try not to look when people are giving me injections, I was under the impression that only part of the needle goes in, but actually the whole needle ends up going into your arm. I was so scared when I found out. In fact, I still shudder to think of it now. It turns out that most people have more than enough deltoid muscle to prevent the needle from getting to bone. Even anorexic girls can get shots this way. I got injected first, and it actually wasn't more painful than the injections given to me by experienced nurses. Then it was my turn to give an injection, and when I actually started concentrating, all I saw was this skin and needle. There was a certain detachment that came from this rather narrow field of vision, and giving an injection was also not as hard as I thought it would be. It also helps that you don't have to push very hard to get the needle in, so it doens't seem like you should be causing much pain. The needle is very sharp. *shudder* I still dislike the idea of getting a length of metal stuck into me.

Next were the subcutaneous injections. They actually hurt more than the intramuscular injections. I was surprised because I figured that getting stuck in the fat shouldn't hurt as much as getting stuck in the muscle, but there you go.

We also learned how to take blood pressure, vitals, and how to do a skin prick to test for blood sugar. My blood pressure was 110/70 (hooray!) and my blood sugar was 119 about an hour after eating dinner (also good).

Oh yeah, in case it wasn't clear, we gave a half mL injection of saline per practice shot, which is why I'm now 1mL richer in saline solution.

BLS training

BLS training is Basic Life Support training, though I personally like the name Basic Life Sav,ing training better. Essentially, we learned what to do if a person's heart isn't beating or if they're not breathing, or both. While it may not be obvious at first glance, there are actually a few amusing points in here.

If someone conscious and choking, you're obligated to ask them first before you help them. Let's see how this would go:

"Hi, are you choking?"

Person can't reply because they're choking, but they're making the Universal I'm Choking Sign. (This is a very important sign to remember.)

"I'm a medical student with BLS certification. Can I help you?"

Person shakes head.

"Are you really, really sure? I mean, you could choke to death if someone doesn't help you."

Person shakes head.

At this point, you'd actually be obligated to wait until the person passes out before helping them, but after they pass out, you can do whatever you need to do.

The second amusing point is the first step of the algorithm they give you to determine whether you should do full CPR or just rescue breathing. The first step is to check to see if they're actually conscious and not just napping. Can you imagine the number of overzealous BLS trained people who started giving CPR to old people napping in the park in order for them to make this into an official first step?

Humor aside, the test for certification was pretty easy. There was a written portion, a multiple choice exam which took about ten minutes. Each question had at least one choice which sounded ridiculous and was obviously wrong. The practical was on practice dummies. Proctors would give you various scenarios and ask you what to do and to demonstrate on the dummy.

Easy as this certification was, I do feel a little more competent and accomplished. At least if anything this bad happens, I'll know, in theory, what to do which gives me a mild sense of security. I imagine that in practice, it's probably difficult first to get past the disbelief and freaking out, and second to guage whether you're pushing hard enough or breathing properly.

update on Squeaks

She is definitely bigger than she was when she got here just three and a half weeks ago and getting more adorable every day. She's learned how to sit on my shoulder and experimented briefly with sitting on top of my head. This second endeavor ended in disaster. She's also discovered paper bags, so I get to have a lot of fun dumping her into a paper bag along with a little mouse toy or something.

Educationally, she's learning (very, very slowly) that she isn't supposed to jump onto table tops, which brings me to the question of, how much water is it okay to spray on a kitten whilst trying to train her? She's also figured out that she isn't supposed to climb into the dirty laundry basket, mess with electrical wires, or chew on my shoes. See how smart she is?

Unfortunately she still screams, I means squeaks, really loudly sometimes when I leave her, like for showering or cooking purposes. I think I've been able to hear her from outside. Hopefully the neighbors can't hear.

A Vegetarian (but delicious!) Dinner

We went to Green Zebra to celebrate someone's successful PhD defense. It's a vegetarian restaurant (she's a vegetarian) that is pricy but fortunately correspondingly tasty.

First we started off with this and bread:

It's a complimentary bite of a cherry and corn salad type thing. I think I tasted some fennel in it. It was alright. The thing was that it would have been significantly better chilled, which is such an easy thing to do that I was disappointed.

On the other hand, the bread was gorgeous. It was a whole wheat bread with just the right amount of crustiness on the outside and soft on the inside. Unfortunately, I didn't think to take a picture before eating it up with a healthy swipe of butter

Here's the menu:

I ordered the beet salad and the roasted shitake rolls.

I apologize for the poor picture quality. It was one of those dim, atmospheric restaurants.

The salad was the better of the two, and it was good, with a sigh of contenment added at the end. It helps that I like beets, lemon, and goat cheese, all of which were included. It wasn't too light or rabbit-foody because of the beets and friend goat cheese, but the peppery greens and preserved lemon peel kept it fresh and bright.

The shitakes were good but not spectacular. The mushrooms were really well seasoned and cooked, the greens were good, and the potato wrap was good, but it just somehow wasn't that exciting. I think it was because texture was sort of bland, if that word can be used to describe a texture. The foam on top was also a little odd. It actually reminds me of fat foam, so it was a little off-putting.

For dessert I ordered dark chocolate beignets with bananas foster and creme fraiche ice cream. I'm a little sheepish to say that I ate most of it before I took a picture, but that was because it was DELICIOUS!

Anyway, you can still see the important components. The beignet is in the back left, the remaining lump of ice cream is in the back right, and a couple bananas foster are in the front. The bananas themselves were on the green side, so it wasn't too sweet, the ice cream was tart and was a good match for both the bananas and beignet, and the beignets had some melty dark chocolate filling on the inside.

Fat foam

Since I haven't posted anything disgusting in a while, let me say a few words about fat. Cadaver fat. Cadavers have this yellow fat in little squishy pellets that pack together in subcutaenous connective tissue, which by the way, is called fascia. I like this word. Fascia. Anyway, The Body hasn't actually got a lot of fat in general, but the other groups body does. When they dissected the butt, they came up with a solid layer of fat about three inches thick. This really makes me wonder how much fat I have stored away because she doesn't look all that big. And especially now since her leg and arm fat have been removed. Oh yes, so both cadavers are significantly lighter now with all this fat gone. It makes them a lot easier to flip.

Even though he is pretty thin, The Body does have some fat, and a lot of it behind the knee, which is a place I never would have thought to look for fat. Who's ever trying to lose behind the knee fat? Nevertheless, there is a great deal of it there. And as we try to dissect it out, it melts underneath our tools and hands and forms this liquidy yellow movie popcorn liquid (sorry) that foams. We were just saying yesterday that it might be more useful to dissect with a grapefruit spoon because this way we could spoon the fat as we cut.

I'm not entirely sure why the fat melts so easily, but perhaps it has something to do with the fixing process. If it really melts this easily, then for weight loss people should just sit in a hot room for a while and let it all drip off.

More updates on The Body: We're allowed to know his first name, which is Harold. He died of pneumonia at the age of 67 in the hospital. We've found two fake plastic tubes which we think are replacement femoral arteries. He also has some metal in his knee, so we think that he'll have a replacement knee, though we haven't dissected it out completely yet. Isn't this like an episode of CSI? There's actually a day later on where a pathologist will come through and take a look at the bodies, which I'm looking forward to.

A great post for after the chocolate cake post, no? By the way, I've been eating the chocolate cake for breakfast with milk tea, which makes me a very happy breakfaster indeed.

Cake Happiness - chocolate cake with cherries

First, two layers of chocolate cake made following THE chocolate cake recipe from allrecipes.com (dark chocolate cake I).

Then lots of pitted and quartered cherries which stained my fingernails purple for a day.

With some whipped cream added.

Then, tada!

A chocolate cherry cake to commemorate our first anatomy exam. A bit lopsided because I didn't bother leveling the layers and was afriad to put filling to close to the edge, but still a big yum. It's also a celebratory cake, because I passed! At least the practical portion. I now know more about the upper limb (technically, only the part from the shoulder to the elbow is called the arm) than I really ever intended to.

Lace scarf is complete!

I actually blocked this scarf, which I was really excited about. Previously I've worked mostly with synthetic yarns which were pretty much unblockable, so lace patterns didn't look as spectacular as they should have. Unfortunately, I don't remember what yarn this is, and I've lost the label somewhere enroute to Europe, but it's a handpainted wool. The pattern can be found on knitty.com: http://knitty.com/ISSUEspring07/KSPalette.html.

The picture above is a close up of the wet lace as it was blocking, and below is a picture of my blocking set up.

And here at last is the finished product! I'm waiting for winter to come so that I can wear it.

First a rant, and then CUTENESS

So the girl I was having an argument with earlier who said that she wouldn't go to or trust a doctor who couldn't pass a physics for physics major class also said that during her first year of medical school, her goal was to just do barely enough to pass. To know just enough to score a 65%. Now who's the crappy doctor!? Who would want a doctor who didn't take medicine or her future patients' lives seriously enough to want to know all that she was capable of absorbing and in fact actively tried to not know more than was absolutely necessary to pass? What kind of double standard is that? She wants her doctor, all doctors, to be of the highest caliber, but she wants to be a doctor who is only just this side of failure, and the closer to that line the better.

And now for the adorable, fuzzy bundle of cuteness that is Squeaky! Her big debut:

It's actually rather difficult to take pictures of her because the camera wants to shine this red light to get rid of red eye, and this makes her want to pounce. And there's also a slight noise which make her want to pounce. And the little dangly wrist strap doesn't help either.

You should be careful with your armpit.

There's a lot of important stuff in it, is my conclusion from today's dissection. There are big nerves and arteries that feed into the arm, chest, and back. The nerves and arteries there are much bigger than I ever expected nerve bundles (other than the spinal cord) and arteries to get. The axillary artery was the size I expected the aorta to be, but it was probably a centimeter in diameter on our emaciated and formalin fixed Body. And maybe all those nerves in the armpit is why it's so ticklish? Also, there's a lot of blood left in the veins. We dissect out most veins to clear the field of dissection, and the blood in there is clotted and gross. You can still get bled on by a cadaver.

For dinner yesterday, we went to a Szechuan restaurant in Chinatown. Yeah, I know, great topic for after the icky clotted cadaver blood, right? But anyway, it had a good level of spice, too much oil, and a bit too much salt. We ordered:

1. crispy eggplant - good flavor, texture was more chewy on the outside than crispy
2. orange beef - too sweet and sticky
3. pea sprouts - good and clean tasting
4. cumin lamb - okay, the one I had in Cupertino a lot was much better
5. Mapo tofu - okay
6. crisped pepper with chicken - way too many peppers, too little chicken
7. salt and pepper shrimp - okay, fry was alright, shrimp themselves were not particularly succulent or flavorful
8. house noodles - too spicy for me to appreciate
9. and on the house: a cold spicy cabbage dish - crisp and refreshing with a kick, very nice

Overall a mediocre experience. But since we were in Chinatown, I finally got stocked up on soy sauce, sesame oil, hot sauce, and ginger candy (good for after dissection)! Hooray!

KittenKittenKittenKittenKittenKitten

Yay! She arrived last night! She's about 6 weeks old, which is pretty young to be seperated from mother and little, but I think she's been doing okay. She has some separation anxiety when I leave, but right now she is sleeping on my lap. This makes me loathe to stand up and get my camera so that I can upload pictures to show you how absolutely adorable she is. I am contemplating names. The frontrunner as of now is Squeaks because she is quite squeaky. The name given to her by her original owners was Tigs.

Last night I saw fireflies! It was amazing! Probably the first time I've seen them en masse flashing on and off. They flash greener than I thought they would, and the flashes don't last for very long, but what a fanciful, whimsical scene they make for.

I have some complaints about the course we're taking. The reading assignments don't match up well with either lecture or dissection. And I feel like a guinea pig, for more reasons than that.

The Anatomical Position

"The anatomical position is feet together and hands forward." Then as an afterthought, "And penis erect."

-from our anatomy professor

The Body turns out to be rather emaciated and old. He has no fat worth speaking of, the muscles are really really thin, and there's a lot of bruising. Today we skinned the back and peeled back the trapezius and rhomboid. They come up and it's like flipping through pages in a book! Only he's got such thin pages. Probably on a few millimeters thick. It's definitely a contrast to the super-buff people shown in the textbooks.

The Body

At I type this out, I am furiously chewing on some very minty gum. The super-duper-heavy-duty-minty gum a la LW or BK might come in handy this quarter. I am chewing this gum because today we met The Body. The Body, by the way, is an African American male. I can't tell how old he is, but he's still got a bunch of tubes sutured into him, so he wasn't in very good shape when he died. He does, however, have a nicely shaped skull, from what I can tell. It is slightly deformed because they opened it to take out the skull.

No cutting was done today; all we did was wrap the body. It turns out that we wrap bodies in strips of rags soaked in a dilute phenol solution (eeeww! carcinogen!) to help them retain moisture and to prevent fungal growth. So essentially, we made a mummy. The heads, hands, and feet have, in addition to the sheets, a black plastic bag over them as an extra barrier to dehydration. Putting a black plastic bag over the head was weird, but in a way I'm glad that we did because it depersonalizes the body.

Mummy making did not take long, so afterwards we went out for coffee. I ordered a Mexicana milkshake which I've been meaning to try for weeks. It was good -- not overly sweet with some nice crunchy bits mixed in. It was pleasant to sit out there in the sun, sipping on a milkshake, in good company. But half way through it, I suddenly caught a whiff of cadaver. Eventually it felt like the smell was caught in the back of my throat, and while it wasn't that bad in the context of a dissection room, I couldn't drink milkshake anymore. I tasted the smell when I swallowed, the the crunchy bits made me want to gag. And that is why the rest of the milkshake is in the fridge and I am furiously chewing gum.

Friday night dinner

Dinner, Friday night, at a gastropub, Publican. I'm really sad I didn't have a chance to take pictures, but it would have been a little awkward.

1. bread: okay
2. french fries with mayonaisse: extra thick mayonaisse with extra crispy fries
3. fried pork rind: about what you would expect
4. ham and pickle variety plate (head cheese, pork pie, pork terrine, sausage, pickled green beans & caper berries): caper berries were big and juicy; terrine was yummy, but I've never had terrine before, so it's hard to say; head cheese was better than expected
5. cured ham plate: yum!
6. crudites: it didn't have enough fish flavor and texture
7. seafood stew: amazing! the salt cod had great texture and a clean but still intensely seafoody flavor; delicious seafood/tomato base
8. ribs: yum! good cut of meat, cooked just right, smoky flavor
9. cauliflour: with anchovies, too salty
10. peas with pea flan: too full to evaluate properly, however it seemed not bad but a little weird
11. giandua panna cotta + raspberry + anise cookie: raspberry compote overpowered the otherwise wonderful panna cotta, but I ate them seperately, so I was still happy
12. hard apple cider
13. sip of "the champagne of beers:" sweet and sparkly

For non-food/drink factors: It's very crowded with little or no space between different groups. It's very loud because it's got a high ceiling and it's full of hard surfaces. The bathrooms are nice. They have very high ceilings, very tall wooden doors (real, actual doors, not flimsy stall doors) and are clean despite that crowd. Sinks are located in the bathroom "lobby" which also have the aforementioned tall doors leading to individual men's and women's bathrooms. There are two men's bathrooms and three women's bathrooms which I appreciate.^^

I left full and happy.=)

Tonight for dinner, I cooked butter glazed carrots with cumin and green onions. I over cooked the carrots a bit, and the green onion flavor didn't come out as much as I had hoped, but cumin is my new favorite spice. Maybe I'll try this again with an onion instead of green onions. And a little hot sauce?

Now, to leave the dinner theme, I got my ears pierced! One ear is slightly but discernably swollen relative to the other one, which is a bit worrying, but we will see. I shall clean fastidiously.

Also, anatomy started today! This means lots of reading! So much reading! It is slightly cool because I can try and feel stuff on my back or move and see if I can tell which muscles are involved. And now, back to reading...

Quote of the day:

"It looks like a crumb cake, but it's not!"

-Regarding a photo of a polyp ridden piece of colon. Trust me lady, there was no way that looked like something I'd consider eating.

Translational research course: done!

Today, I got poked by needles three times. Once for a blood draw, once for a tetanus booster, and once for a TB test. Needles scare me, which might make medicine a bad choice for me (my hope is I'll be fine if I'm the poker and not the pokee), but the nurses were wonderful with them and I got through it with minimum discomfort. One of them had been at it for 26 YEARS. That's longer than I've been alive. I wonder how long it will take me to get good at poking people with needles.

Hilights of the 4th of July weekend:

1. Fireworks! With smiley faces!
2. Adler Planetarium. It turns out that planetariums are WONDERFUL places for me to nap. The chairs are comfortable and reclined. Good scenery. There's soothing music playing in the background. It's darker in there than my room gets at night. Those were the best afternoon naps I've had in a long time. We watched four shows and I slept blissfully through at least half of two of them.
3. German ham pizza with Granny apple chunks and sundried tomatoes at Medeci. It would have been better with less cheese, sharper cheese, more apples, and sliced apples instead of diced apples, but it's a good idea. I'll have to try making a variant of it myself sometime. I also discovered that pizza goes surprisingly well with dijon mustard. But maybe that's just me.
4. I acquired pins, so now I can block the lace scarf that I finally finished knitting!

In other news, we have finished the neurology section (I don't think I'm going to be a neurologist when I grow up) and started the surgery section. We had two great talks today, one about virotherapy for cancer and the second about Pseudomonas host-pathogen interactions in the gut.

The virotherapy guy is engineering viruses to treat brain tumors which would be able to replicate specifically in tumor cells and thus kill only the tumors, leaving healthy tissue untouched. His strategy is to implement two levels of control. The first is receptor based and involves engineering ligands on the virus which are specific to receptors on tumor cells. The second is based on engineering the viral genome such that a gene necessary for replication is under the control of a promoter turned on by a transcription factor present only in tumor cells. By some stroke of luck, this promoter is also radioinducible. (!) It reminds me of Onyx's oncolytic viruses. He also has some very cool work on specific delivery of toxic nanoparticles to tumors.

The Pseudomonas guy described a system whereby Pseudomonas can tell how stressed out their host is and decide whether or not they should start expressing virulence factors to get the hell out of there. The idea is that if the host (a person) is healthy and fine, then the Pseudomonas are perfectly happy right where they are. They're actually a normal part of the microflora. But if the person is dying, then the Pseudomonas don't want to die with the person and so they express these virulence factors which the person doesn't like. Stresses like high immune system activity, low blood flow, and low levels of nutrients can actually trigger quorum sensing (bacteria secrete a small molecule so that they can collectively determine their population density), then biofilm formation, then secretion of virulence factors which hasten the host's decline. Based on this, you can think about treatment of a patient not by killing off the bacteria but just by tricking the bacteria into thinking that everything is a-okay. Clever, no?

I wonder, though, whether I judge too much based on how good the speaker is. Is there some part of me that subconsciously likes certain topics just because they're well presented or is there something inherent to their work which appeals to me? It's kind of worrying because I don't want to make a decision about the type of research I do based on the charismatically it's presented.

I was arguing with a classmate today, and the issue is still sort of on my mind. The university is instituting a system whereby pre-med (or mostly pre-med) students take a "watered down" version of a basic science course. The problem is that now a bunch of them fail these basic science courses. From what I could understand, she has several issues that came up as a result of this new policy. However, she was going back and forth on these issues a lot, so my understanding might not be correct. Also, I got the feeling that point one was the most important and she was just bringing up the second two points to justify point one. So, without further ado, allow me to unload my mind:

1. She doesn't want the university to take sub-par students and graduate sub-par students.
2. She doesn't think that people who can't pass a basic science course at the university should be doctors.
3. She thinks that there should be an equitable distribution of talented doctors geographically such that people who live in rural Alaska will have access to the same standard of care available in a major city.

For her first point, fair enough; I don't really care.

For the second point, I think that it lends itself to a great amount of pickiness. If she's not willing to be treated by a doctor who can't pass a basic science course at this particular university, then she's ruling out a lot of talented doctors. At Berkeley, there are different basic science courses for different types of people. For example, there's a physics course for physics majors, a physics course for non-physics science majors, and a physics course for "presidents," the rationale being that if you don't want to be a physicists, then there are things it's not worth your time to learn. The pre-meds take the one for non-physics science majors. By her standard, she would be unwilling to be treated by a doctor coming out of Berkeley, but Berkeley is a world class institution that I'm sure has produced a number of extremely competent doctors.

There might also be a sub-point here in which she thinks that if you don't pass physics for physics majors, you just won't be a competent doctor. If this is the case, then there are a lot of incompetent doctors out there, probably working in rural middle-of-nowhere areas, which is an injustice.

And now we come to the third point. My thought is that in order to be a doctor at all, you have to do decently on the MCAT and pass three board exams. At this point, I assume that you are competent. However, there is always going to be a spectrum of ability, and so the best will have more choice in where they will go. It is more likely that they will choose to work in a big city with a good hospital. In fact, working in this kind of environment will help them be good doctors, since there are so many other specialists around to consult with. Being in a city is also pretty much necessary for research. So if the best and the brightest tend to go to big cities, and being in a big city helps them be excellent doctors and scientists, then of course there will be an inequitable distribution of talent geographically. It might be unfair, but since I assume that after passing three boards, all doctors are competent, I think that it's acceptable. Putting the best doctors in rural areas might actually be considered an injustice as well, as fewer people will have access to their care. In a city, they'll be able to specialize and have a bigger patient population which is a better use of talent for society as a whole.

Quote of the day:

"An MSTP is worse than a marriage! It has to be seven to eight years long." Oh, my goodness, I hope I know what I've gotten myself into.

Today the cool thing was mouse echocardiograms! An echocardiogram is an ultrasound of the heart, and an ultrasound is essentially a sound reflection. The probe produces a sound wave at a particular frequency (higher than the human ear can hear, hence "ultrasound") and focuses it on a point within the body. As the sound waves travel, they will encounter different types of fluids and tissue which cause them to reflect back differentially. The probe recieves these echos and software is used to convert this information into a digital image. Amazing! To do a mouse echocardiogram, you:

1. shave the mouse's chest
2. Nair the mouse's chest to really get rid of residual hair
3. anesthesize the mouse (I think today the mouse was breathing in vaporized isoflurane through this cute miniature face mask set up.)
4. tape the mouse up to a special platform to allow monitoring of heart rate and temperature control
5. put a big dab of prewarmed ultrasound gel onto hairless chest
6. put probe down on chest and image heart

Mouse hearts beat much faster than human hearts, so the probe has to be able to generate a much higher frequency wave than one used on humans. The machine cost $300,000! You end up with a 2D movie of a section through the heart as it beats, although with the aid of computer programs you can come up with a 3D model, and visualization of blood velocity (based on Doppler effect). By the way, I think mice are really cute, which is perhaps why I decided that mouse echocardiograms were cooler than human echocardiograms. Also, we got to see a mouse echocardiogram live, but not a human one.

http://www.youtube.com/watch?v=7TWu0_Gklzo&feature=related

This is a video with a couple of human echocardiograms. I like how the flaps of the valves look like they're just sort of playing a clapping game. They're so cheery and energetic. The colors that show up indicate the velocity of blood flow. My understanding is that conventions may differ between hospitals, but essentially, red indicates blood flowing in one direction and blue the opposite. The intensity of the color indicates speed. Areas of mixing and turbulence then result in the other colors that you see.

The other cool thing today was confocol microscopy of mitrochondria! It turns out that they aren't like those jellybean things that show up in textbooks but are actually more like a couple strands of spaghetti thrown down onto a plate, and bits of the spaghetti can break off and fuse with other pieces of spaghetti. Apparently this has been known for a while, but I had no idea!

And lastly, while I was looking for stuff on confocal microscopy of mitochondria, and found this, a song about the Golgi apparatus set to images from confocal microsopy of the Golgi apparatus:

http://www.youtube.com/watch?v=cnK7RT1q0bA

It's really beyond words.

As part of a translational research course we're taking in the first summer of our MSTP, we're spending a few days going through the major clinical specialties. We started in pathology, went through pediatrics, and are now doing medicine. The morning is typically devoted to showing the clinical side of things, while the afternoon is spent listening to several research talks from people in the department so that we can get an idea of the kind of research people in that deparment do. It's a wonderful idea, I think, because I can get a sense of what doctors do in a clinical setting, which was definitely a mystery to me before this and upon second thought may actually still be, because the impression I get is that doctors go to a large number of meetings every day, which I'm not entirely sure is accurate or not. Also, I've been getting a sense of the kind of research people do here and the atmosphere in which they do it in.

We've spent these past two days in internal medicine, and during this time we've seen some amazing things. What comes to mind first is radiology. Man, those people can look at smudgings in gradients of black, white, and gray and see actual things. It's like magic. Today we went to the GI/Oncology multidisciplinary conference during which patient cases are reviewed by a number of difference specialists. Typically (I say typically, but really, I was only there once), someone starts presenting a case: "So and so presented with this and that..." They go through the patient's history, current problems, labs, and radiology. Then at some point they will decide whether the tumor is operable or not. At this point, they show X-rays and CT scans on the screen. X-rays are single images, but CT scans are dozens, if not hundreds, of pictures of sections taken at tiny intervals down the body. When they show CT scans, they flip through rapidly, so it's like watching a film of the inside of the body as you travel from neck to waist. As they look at these pictures, they say things about the tumor like, "That's a really bad one," or "it's totally wrapped around this or that," and I won't see ANYTHING. There is NOTHING on that screen that makes sense to me. They're doing something totally beyond me to glean information from those pictures. And it's both strange and amazing to think that in 8 years (give or take a year), I'll be able to at least see the structures they're pointing out inside that greyish blur, and it won't seem like magic anymore, but merely a trained eye.