Neuro is awesome

So, as I was sitting here with Dr. Kandel's massive Principles of Neural Science (excellent text, by the way; he does for neuro what Costanzo does for physio), I thought:

"Hey! I actually understand why GABA channels are inhibitory and glutamate receptors are excitatory! And therefore how barbituates work!"

You must forgive me for the exclamation points. These moments of total clarity are far between in med school, where I usually feel like I'm about ten steps behind where I need to be.

Back when I was a starry-eyed undergrad having crises about med school vs. grad school, several people explained to me that the difference between the two was that med school is all about memorization, and grad school is all about integrative thinking. Although there is a great deal of memorization in med school (especially for anatomy), it's mostly in terms of learning a new vocabulary. Kind of like having to memorize all those axioms for geometry in middle school. Once you have the basics down, things actually do start to make sense. Sometimes.

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Now playing: Stephen Sondheim - The Worst Pies in London
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Thoughts on economic theory

Thanks to recent lectures, I've been thinking a lot recently about the role that economics plays in our health care system hodge-podge. I've found that economists tend to have an extremely narrow worldview. For them, it's all about the money. To some degree, this is pervasive in our country. Measures of success or failure are, almost entirely, monetary.

I disagree. Sure, money is important, but it is by no means the most important factor in health care, even in a country where costs are spiraling out of control. Money's useful as a means to an end, but as Kaufman and Hart so hilariously reminded us in the 1930s, you can't take it with you. Monetary measures of success make even less sense in a health care context, where so many people are driven by intellectual curiosity and a desire to be useful. As newbies on SDN are regularly advised, medicine provides some job security, but if you're in it for the money, get out now.

Here's the thing. Beyond a certain personally-determined point (say, 30k, 50k, 80k -- whatever), income doesn't really matter any more. Obviously, everyone's balance point is different and depends on things like educational background, career choice, personal goals, family situation, etc. My own limit, based on my educational debt and the fact that I'm not going to have a real job until about 10 years after many of my peers, is somewhere in the region of 50k; much less than that and I might consider leaving medicine (and doing what else? writing?) Once your basic needs are met, the rest is just fluff.

I took a fantastic literary theory class in college, which made me by turns a structuralist, a psychoanalyst, a deconstructionist, and a Marxist. (I remember when I told my parents that one.) Literary Marxism, which is quite different from its economic cousin, is the view that money and class are the most important motivators. I suppose that I am therefore now an anti-Marxist. (Theory-wise, I'd peg myself for a deconstructionist at the moment. The reader brings more to the text than many other theories allow for. But that's a story for another blog.)

To recap: economics isn't everything. In fact, it may well have been an over-reliance on economic theories that got our health care system in the current mess. As Lange's excellent Understanding Health Policy states, health care is not a good in the same way that DVD players are a good -- it's too unpredictable, for one. Economics has been the driving ideology of health care at least since the turn of the last century, when charitable almshouses began consolidating into hospitals. Perhaps the debate on universal health care should turn to a different model, one that addresses both the motivations of physicians and the needs of patients.

ED Shadowing

Today I spent four hours shadowing in the peds ED, an opportunity set up by the peds interest group here. I love being in the hospital and seeing patients, even if as a first-year med student I don't get to do much. (Though I examined a fifteen-month-old today!) I'm also impressed by how much the attendings, residents, and even third year med students, seem to enjoy teaching. Every five minutes, someone came up to me and was like "Wanna see a lupus case?"

There were mostly what the attending called bread-and-butter cases, the sorts of things that could and should really be seen by a generalist. But a couple of True Emergencies, brought in on stretchers by paramedics. So... a nice mix, I suppose.

The atmosphere fairly crackled with adrenaline pretty much the whole time I was there, even during the slow moments. Emergency certainly attracted a particular crowd, I can say that. After just 4 hours, I'm not quite sure if it's my style, but I like the thinking-on-your-feet aspect of it. We'll see.

Stepford Wives

So, as I was making dinner (whole wheat pasta: delicious and nutritious, and most importantly, cheap) in the common kitchen attached to the dorm lounge, one of my classmates came up and started cooking. She boiled some water on the other burner, and pulled several vegetables out of her plastic bags, along with a tupperware full of grilled chicken, and began a-chopping.

"Smells delicious," I commented after a few minutes. "What are you making?"

"Chicken noodle soup, but I'm cheating."

At which point she showed me a package of noodles shaped like roosters. (They were exceedingly cute.) Then she dumped them in her boiling water and proceeded to add all the fresh vegetables, chicken, etc.

How is this cheating? Would not-cheating have been making the noodles by hand, like Lucy and Ethel in the Pioneers episode of I Love Lucy?

More to the point, are there actually people out there who cook things from scratch? One of my friends made homemade icing for our post-exam party, and just this evening, someone else was making and baking five dozen cookies, from scratch. I get the impression that mixes and shortcuts are frowned upon, only to be used by Evil Mommies Who Love Their Jobs More Than Their Kids. It's like living in the 1950s, except this is 2008 and we are med students and we have negative free time. (Though I did go skating at Bryant Park today. And afterwards I studied in the New York Public Library. Because I am a med student.)

I know a few basic recipes, mostly so that I can avoid living entirely on Ramen. (I did that for a semester in college. I saved tons of money, but it was terrible.) And I love to cook, but I also love to pass my exams. So when it comes to Betty Crocker cake mix or Goya's flan thing, I'm totally there.

From Moore's Clinically Oriented Anatomy, 5/e, 937

Happy New Year

2007 was a crazy year for me, what with getting into the med school I attend, writing my thesis, graduating college, moving very far away from home, learning 10,000 new facts (according to our Dean of Students), struggling with the emotional aspects of dissection, making new friends, and just generally stretching myself in ways I would never had thought possible on January 1, 2007.

Huh, I wasn't going to recap the past year, but I suppose I already did. =)

I hope to post here a little more frequently this year. Once a week, at least.

Classes start again tomorrow. I resolved no more than 2 cups of coffee a day; we'll see how long that one lasts.

Apoptosis tongue-twister

From the transcript for this lecture:

There are other members of this family that are pro-death factors: three examples are bak, bax, and bim. In a normal healthy cell, bak and bax are normally present; however bak is bound by bcl-2, which neutralizes it, and bax is in the cytoplasm, where it can't do much in terms of mitochondria. Bim is present in low levels. When a cell gets a signal to cause death, bim levels go up, bax and bim move into the mitochondrion, and bim binds to bcl-2, displacing bak and neutralizing bcl-2. And now bak binds to bax, when bax and bak bind to one another they form a pore and this pore permits the release of cytochrome c from the mitochondrion. This then binds to APAF1, which binds to caspase 9, which then activates caspase 2, causing death.

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Now playing: Newsies - King of New York
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If anything deserves an interrobang, it's this

Haha, so unprepared for tomorrow, it's not really funny but I cannot force myself to care anymore.

So close, so close to being done with one-eighth of my medical education HOW DID THAT HAPPEN?!

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Now playing: Wolfgang Amadeus Mozart - Piano Concerto in A, K. 488, I
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You see this? Imagine it in black and white and about half the size, and you'll get an idea of the pictures in my anatomy syllabus-textbook-thingy, written by the course director during the Nixon Administration and apparently illustrated by a three year old with no sense of proportion or relationships.

I mean, the big orange thing in the middle is, I think, supposed to be a uterus, but why does it have a zipper up the middle? Why are the ovary and uterine tube popping out of the fundus, like the spinning thing on a beanie, totally unsupported by mesometrium?

There is also a small plastic earring back (or maybe a cigarette) impaled in the bladder-like thing, and the bizarrely transected rectum appears to be receiving arterial supply and venous drainage directly from the sacrum.

Thank goodness for Netter.

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Now playing: Ragtime - Prologue: Ragtime
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The more I study, the more my lack of knowledge becomes apparent. It's frightening.

Also, I do not understand why we have the longest anatomy course in the country (August through March), yet I'm still always cramming. Either other schools learn less or I am just not getting it

I can't wait for next Friday, when I'll bubble in my last exam and then have a whole ten days off. Gosh, I don't know what I'll do with myself. The last time we had days off with genuinely nothing to study was a weekend after our October exam week.