Our Own Little Strange Acoustic Flash Mob Bette Midler Style

Okay so maybe the title was a little long and self-indulgent, and maybe I should be studying for my mock full length USMLE exam tomorrow morning, but...meh...the canker sores in my mouth and recent surge in nocturnal teeth grinding tells me I could probably use a night off.

Besides, how can I study for the USMLE when I am still buzzing with school-girl-giddiness from our little strange home grown acoustic flash mob (if that is what you'd call it) performance we pulled off today?!? 

To set the stage, it was our last anatomy class*, designed as mostly a review session. Prior to class we rehearsed about 5 times with a handful of people who agreed to be a part of it. All of us were absolutely vibrating in our seats for the whole session, anxious for the cue to start. We told the other faculty and Dean that it was going to happen at noon and they gathered outside in the hall. We had already distributed little flags with a picture of his face on them (see photo below) and sheet music.

Anyway, I'll let you watch for yourself...it starts a bit rough but I figure we pulled it together nicely by the end.

He was definitely surprised, and even a little teary, I think. I've probably watched the video about 30 times and just can't get the grin off my face. It was an absolute blast and I think an appropriate send off. He's a tough Prof, but very good. He has worked hard to design a very clinically relevant anatomy program, and it shows. I am actually going to miss anatomy. Little bit.

The photo we mounted on little sticks.

Now I am going to have to start brainstorming. Grad is only two years away! We put that together with one 30 min rehearsal---we could have a three ring bloody circus by 2013 if we get cracking!!

--

*Usually the class consists of our prof lining us up and drilling us for half an hour, in small groups of about 20. We've had this class every week for the past two years. Yeah, two years of anatomy. He's a very, shall we say, intimidating, gruff man, with an impressive CV about as thick as your arm (if you have thick arms) and a very short fuse for wrong answers. He's the one that tells us to die or hang yourself or jump off a bridge if you say that the facial nerve is the sensory nerve of the face (it's the trigeminal) or something along those lines.

Medical Jargon

When a health care worker becomes a patient, is it lame or appropriate for them to use medical terminology when talking to their care providers?

I am (as usual) on the fence with this one.

A part of me finds it borderline irritating sometimes when people present to triage and say things like, "I've had some discomfort beneath my xiphisternum for the past three days, not sure if it is from the NSAIDS that I've been taking or if it is a hiatal hernia, or what.." Or "my nephew has just fallen skiing, I am pretty sure he's torn or partially torn his ACL, his drawer test is positive and he's not weight bearing".

Naturally the thoughts running through my head will include; "are you telling me this as a secret hint that you are a HCW and therefore should be seen more quickly than the sicker people in the waiting room?", "are you using medical language because of it's precision and beauty, or as an attempt to make my assessment easier?", or "are you having a difficult time accepting that you are a patient and are trying to desperately hold on to your normal power position in this setting?"

And then I realise that I am probably over-thinking the whole thing. Yet the feeling of vague annoyance lingers.

Of course, when I went to the sports med clinic with my shin splints a few years ago I wrote, "bilateral anterior tibial pain" under the chief complaint box. Why didn't I write "shin splints"? Well partly because I didn't know for sure if that is what it was, "leg pain" seemed too vague and I could perfectly describe the area of discomfort using those words. I am pretty sure the MD who saw me thought it was douche-y (the only explanation for his terrible assessment and treatment).

Since then I try to just let go, accept that I am the patient and write things like "knee pain" in the chief complaint box when I go to see the orthopod. Even through it is "midline, subpatellar discomfort on palpation and with weight bearing exercise".

Thoughts?

All Quiet

I needed a couple of days away from my computer screen and away from the confines of my office. Now that I've read a few hundred pages of my book, slept in, gone for walks, talked to my family, prepared a turkey feast for 10 people (on one hours notice), and worn my housecoat for >5h straight...I feel like I can sit in here and stare at my computer screen again.

It's been wholly up-and-downish since my last exam (anatomy spotter of doom) on Wednesday afternoon. If you want a more detailed account of how those exams work I linked to my previous explanations in the last post. A quick and dirty version: there are 25 desks, 50 questions. 1 minute per question. When the buzzer goes, after two minutes, you get up and move to the next desk. Everyone starts at a different point on the exam, this time I started at question #15.

I was flying! Remember, these exams are designed to make grown men cry (and they do). This semester I opted for a different study tack, and I think I cracked the code. Our anatomy prof gives us about 15-25 images each week with our learning objectives for the case. That is what most people study on because often it is these images that turn up on the exams. Now that we've been in school for a year and a half this means the amount of slides that could be chosen from are >600. Instead of madly trying to go through all the slides from the past I picked the concepts that keep coming up and looked at as many images of those things, from different sources--especially imaging atlases (because I am really trying to train myself to visualize the 3D version of x-rays, CT, MRI). I spent time reading up on hernias, embryology of the face, cardiac circulation, head injuries, lung pathologies, etc. in general and avoided my notes all together.

It totally worked. The first 10 questions seemed almost laughably easy. I was trying not to grin at how well prepared I felt and how much I was ROCKING THIS EXAM!! Oh what a feeling.

Hang on. 

I am supposed to be at question 26. But I am at question 25 on my bubble sheet? BUZZZZZZZZZZ!!! (i.e. move to the next station)

NOOOOOOOOOOOOOOOooooooooooooooooooooooooooooooooooooooo. 

Yep. Somehow I got out of sync with the numbers, I missed filling in a bubble somewhere. Somewhere between the vagus nerve question and the head injury one.

Oh God. I am going to vomit. What question am I looking at now. Yes, ok fine common fibular nerve question...ok should I try and figure out where I made the mistake? Should I flag my prof down? I thought for sure that vagus question the answer was "D" but it looks like I put "E", maybe that is where I screwed up, maybe...BUZZZZZZZZZZZZZZ!!!

Ok I am going to be sick. No, don't be sick. Forget it. Move on. Finish this exam as well as possible. FINISH in STYLE. Don't have a meltdown now. Don't vomit now.

Head in the game. Game face. Bring it.

I finished the exam. Told my prof on the way out that I'd gotten out of sync somewhere between 15 (where I started) and 26. He just said "Oh, ABB!" with genuine empathy and disappointment for me. He said he'd look through my answers and try to rectify the situation if he could.

It was actually too much. He's a real hard ass, so getting his very kind response brought on wave of nausea number three--I bolted.

Home, called my mother. Cried. Composed myself and called my prof. I told him I didn't expect he could really fix anything but that I'd told him only because my ego/vanity couldn't handle the thought that he wouldn't see the mark that I had been on my way to getting. I know, I lost prob max 10-12% in the mistake (and maybe a smattering more due to the momentary panic), but that I passed overal. Thing is, I don't obsess about grades. I want to learn this stuff for the sake of being an excellent, safe, competent physician. I can't even tell you what I got last year because I looked at my marks and then forgot about them. But for once, and for the first time in medical school I felt like everything came together during an exam!

He told me not to worry, the exam was only worth 14% of my total marks for the year and that it would in no way compromise my academic standing overall. We wished each other a Merry Christmas and hung up.

I changed from my nervous-sweat-soaked t-shirt and headed to the pub. I suddenly missed my friends and classmates and I wanted nothing more than to be getting "yay we're done!" hugs and drinking a Guinness. It was over, I was past it, and I wanted to reclaim the celebratory feeling that I deserved.

I reclaimed it and it has been a sweet, sunny, quiet few days since.

In Kicking Myself For Not Asking...

I always ask questions at the end of lecture. Barely anyone else ever does which I find weird and borderline irritating. I feel like saying "Really? No one has a question? This nephrologist just lectured to us for 2 hours and everything was crystal clear--you have never wanted to ask a nephrologist anything?"

Sometimes I bite my tongue, or just ask after class because even though a really big part of me doesn't care what the other students think of my question asking behaviour, sometimes I just don't want to be that girl. You know, the one who asks questions. Every. Lecture.

Anyway, yesterday I went to an evening presentation by the only peds neurosurgeon in Ireland. Yes, you read that last line correctly. I didn't ask my question because a few people (mostly doctors) in the audience were asking long blow-hard-like-listening-to-their-own-voice-pseudo-questions. Also, I was pretty sure that I must have missed a pivotal aspect of neural tube development/spina bifida/Arnold-Chiari malformations in school because NO ONE ELSE asked and it seemed like a really obvious question (why do repaired spina bifida patients who no longer have ACM's still need shunts, why do they still have hydrocephalus, like forever??)

I kicked myself afterwards because when I ran into my anatomy prof in the parking lot I asked him. He had been wondering the same thing. Anyway, when I was venting my frustration at not asking (and my reasons why) he said,

Everyone waits for someone else to ask the key question.  Evolution taught us to take risks vicariously.

So, anyway. That is my quote for the week. Nay, month.


I think I will get a coffee mug with that written on it. 

5 Down, 3 To Go

So we had another mock spotter on Friday. Each term we have one mock (i.e. it counts for nothing grade-wise) and one final (real) spotter.

These exams are also known as "bell ringers" because you get 1 or 2 minutes per station where you have to determine what it is you are looking at and then answer questions on it--before the GONG goes off and you have to move to the next station.

I have to say, this was the best one so far, for me. I don't think I did wonderfully on it but I feel like I am finally figuring out how to ace these exams.

For one, I used to just about have a seizure whenever I saw this photo:

Human embryo at around 3 weeks. 

But now I am not as freaked out. It's just a teeney, weenie little embryo---and it can't hurt me! I know what the bits do, and what they become, and I am not as easily thrown off by our prof putting random genes in the answer (which I don't know) to trick us.  I just look for the part of the answer I know (like nucleus pulposus or skeletal muscle or whatever) and ignore the via Gli3R protein or in response to Fgf signaling part of the answer. I know, it sounds obvious, but when exam adrenalin is rushing I tend to see those words and BLANK on all the things I do actually understand. Freak out. Run out of time. Guess.

So. I try to breathe. When I get to the next station I force myself to let the last set of questions go. I used to ruminate. There is no time to ruminate.

Also, I am in two amazing study groups (mostly composed of the same people), and we've been preparing for exams since the second week of school. Every week we've made presentations for each other on the salient points from our cases last year. We make up quizzes for each other and handouts, etc. It works really well because you are forced to do the review every week and you want to do a good job (so that you don't look like a slacker for the group presentation). 

2 weeks ago we each made a mock spotter for the group from 7 randomly assigned cases spanning both last year and this year (thus covering all the cases). Making the damn thing was VERY time consuming and it took us 2 three hour sessions just to get through all of them, but we timed them like a real spotter and everything. 

I never realised that the BEST way to study is to try and make exam questions! You really have to think about the concept, how to trick people, how to word questions and make plausible fake answers. Each question took me at least 30-60mins to make. 

Hello. It paid off. There were several of our exact slides on the exam Friday!!

Huzzah!*

The real bonus though is that I only have THREE spotters left in the future of my earthly existence. This makes me very happy. Though I must say, since I've been thinking more and more about pursuing surgery, studying anatomy is less tedious than it was in the past. 

---

*I did have one of those post-exam-facepalms though in the shower yesterday. I was just washing my hair and like a lightening bolt one of the histology slides (that had confused me) popped into my head. I thought that it was liver with the arrow pointing to fibrosis. But the lightening bolt struck and I suddenly remembered doing it in one of our mock exams! Nooooooooooooooooooo! It was a fibrillary tangle in a sample of brain tissue! Ahhhhhhhhhhhhh. Facepalm. Facepalm. Facepalm. Sigh.

Can't win 'em all I guess. 

Spotter Today

In less than 2h.

Eeeek!

Sea Horse? Sea Hell.

One of the main reasons I've kept my sanity recently is due to a video that Whitecoat posted.

If you have two minutes and you want to have a laugh at what happens when the ramblings of a very stoned mind are recorded and then put to brilliant visuals I would advise checking it out.

In other news, I wrote my first final today. The anatomy spotter of doom. I mean, you don't even have good guessing odds as there are always 10 possible answers.

In a new evil twist my prof really got into the negatives this time around.

So I'd get to the station--thinking

"Ok great! That is a clearly a horizontal section of the basal ganglia. Sweet. Bring it! I studied my ovaries off during neuro and can draw you any pathway, inhibitory, excitatory, sensory, motor, direct, indirect...what you got?'

Then I'd read the questions:

If 'A' is damaged at 'B' which answer is not true:

a-a contralateral hemiparesis below the zygoma without lacrimation and without hyperacusis
b- an ipsilateral hemiparesis below the zygoma with lacrimation but not hyperacusis
c-a contralateral hemiparesis without with lacrimation and with hyperacusis
d- an ipsilateral...


"wait--SHIT I am looking for what is NOT true---gah! Now I have to go back to the beginning and read from the start---crap what pathway was I looking at again? Which nerve was that? Which part of the---"

BUUUUUZZZZZZZZZZZZzzzzzzzzzz!!!!!

Next station.

Repeat x 50 questions.

Also the guy behind me in the stations was SNIFFLING and SNOTTING through the entire thing. At one point I was trying to decide between grabbing one of the invigilators and saying "give the MAN a DAMN KLEENEX" or taking my shirt off and throwing it at him to use as a hanky. Note to self, from now on bring tissues for others as well as myself. 

Hello fall re-write.

No one said medical school was easy. But what was all that drivel about 'the hardest thing is getting in'?

Bah.

Now to collect myself for the next three rounds...ding ding!!!

The Easiest Way?

Anatomy prof: "The easiest way to remember which is which---genu valgum (knock-knees) versus genu varum (bowlegged) is to remember hallux valgus, you know, bunions".

Me (in my head): "Actually the easiest way to remember is that "gum" sticks your knees together. As in valgum."

Me (out loud): "Oh yeah, of course...hallux valgus...I'll never get the two mixed up again!"

Mock Anatomy Spotter: About as Hip as a Mock Turtleneck Sweater

(mock turtleneck)

When I was 20 I dated a guy who was in medical school. I remember him telling me about the anatomy spotter exam (they called it a 'bell ringer'). It sounded ugly to me. I envisioned all these really nerdy science freaks staring at bits of bone and looking into microscopes with a loud gong going off every minute or so. People would get so stressed that they'd vomit or get nosebleeds, fainting also wasn't totally uncommon.

I remember thinking...someday I'm going to have to do one of those and I know that I am not going to like it. For those of you who have not had the pleasure of having your cerebellum slapped with a hockey stick (which is what I equate the experience to) this is how it goes.

You sit down, there are 10 people or so in your circuit. In front of you is a laminated 8x10 of something, either a CT image, a dissection image, an xray, an MRI, a photo of a bone, a electron micrograph of an embryo or a photo of a histology slide. You have 2 minutes to answer the two questions, a bell rings and you get up and move to the next set of images/questions.

In the case of my evil anatomy prof the questions were not, "what is a" or "what is b" they were things like "if 'a' is damaged which structures will be affected and how?" or "what is the metabolic process occurring at 'a'?" or "what genes are expressed to ensure differentiation at 'b'?" Of course it wasn't only 4 options, but 8 to choose from as well. Thanks so much for that.

Yeah. It was ugly. And the thing that irritated me was the complete lack of clinical relevance to most of the exercise. Yes I do believe that you have to know your anatomy so well that you can answer questions under pressure in a rapid fire way....but in the 'real' world I am never going to have an unlabeled histology slide sitting in front of me with a patients life hanging in the balance while I figure out if it is from his spleen or his seminiferous tubule. Come to think of it, I am NEVER going to have a histology slide in front of me clinically...ever. That is what lab reports are for. Nor am I going to be staring at the saggital section of a fox jaw trying to decide if the cleft would be in between the canines or the incisors if "a" doesn't fuse with "b".

Bah.

Ok my rant is done. I suppose that the exam had the desired effect: it scared the rubber boots right off me. Hence my 7 hours of dedicated examination of all-things-laryngeal on Sunday rather than reading my fantastic book (Shantaram by Gregory Roberts) or watching the flood waters rise outside the medical sciences building.

(mock spotter)

Courtesy of here.