fear

     If one were to survey med students regarding what motivates them to do well on their exams, I'll bet that 'fear of failure' would rank high on the list.  I know it does for me.  About 2 weeks ago, we took our first mock practical exam in gross anatomy to 'let us know where we were at'.  I guess I should explain how a practical works.  There's a large room where we dissect the cadavers.  The faculty go around and 'tag' structures with a metal pin through a muscle like the 'flexor carpi ulnaris', or a piece of brightly colored string around an artery such as the 'deltoid branch of the thoracoacromial trunk', or an arrow on a radiograph (x-ray, CT, MRI) pointing to the 'greater tubercle'.  Armed with a clipboard, an answer sheet, and a four-leafed clover, we are expected to walk up to a station, observe the structure and write it down.  A bell goes off in 45 seconds and then you repeat.  The 45 seconds of observation go way too quickly but then there are rest stations where the 45 seconds last an eternity.  That goes on for 50 structures.

    So my first practice practical result?  A whopping 10.  And that's on a scale from 0 to 100.  That's right, I had 45 X's on my answer sheet and only 5 checkmarks.  Nothing to write home about unless it's to apologize for being clueless.  Granted, this practical was executed by the pedagogues (student assistants who aced the class in years past and often want to be surgeons) and they admitted that it was much harder than the real one would be (the highest grade I heard was a 50).  But still, a 10?  That doesn't exactly instill confidence.  A week after that one, there was a second mock practical only 3 days before the real exam.  That means if you bomb this one, you only have the weekend to learn the stuff.  I had, shall we say, studied with a bit more enthusiasm.  And this isn't a trivial amount of information.  To give you an idea of the volume, here's the material for Block I, excepting the cadaver.  They tend to frown upon taking body parts home.

This time, I got a 70.  And then I started asking around how others did.  Scores were still in the 50s so I was psyched.  Real practical rolled around on Monday, and they posted the answer key that evening.  We have a carbonless copy of our answers so we can self grade.  Since it's not multiple choice, there is some subjectiveness to what answers they'll accept or reject.  Depending on their degree of mercy, I got somewhere around 80 give or take some points.  And the written part, somehow I managed an 86, a high pass grade only 2 questions shy of honors.

     And I'm left wondering, what could happen if I was actually a diligent student and applied myself?  Knowing myself, I'm pretty sure I'll never know the answer to that question.

tension breaker

I'm bubbling in my horrifically long last name on the scantron while the professor drones on in a monotone voice about the rules of the exam, "no cellphones, no electronic devices, blah, blah, blah."  This is the first exam of Exam Week and it's the doozy gross anatomy so the tension is high.  Then there's a pause where silence settles in over the room and in that same dry and monotone voice, he states:

A man is driving down a lonely country road.  In the opposite lane, a woman is driving down the same country road.  As they begin to pass each other, the woman leans out of her car and yells, "PPPIIIGGG!!!!"  The man leans out his window and yells back, "BITCH!"  Then the man hits a pig in the road and dies.

The whole auditorium errupts into laughter and you can just feel the tension in the room lessen.  I've come to really love the faculty at my school.

review - the alchemist

While sitting in the waiting room for my brother's MRI down at MDACC, I happened to look next to me at the book shelf.  The first book jumped right out at me.  Titled The Alchemist, it is ironically "a fable about following your dreams".  I had never heard of it or the author but I took it home and gave it a go.  How could I turn down a book about omens when I basically find it as an omen?  It's a simple, yet not simplistic, beautiful story.  I'm not even sure how to explain it other than to say:

READ THIS BOOK

In retrospect, it's an enormously popular book that flew off the book shelves in the 80s and 90s.  I can see why.  I wonder if I had read this book earlier in my life, would I have made a career change earlier.  It's one of those books that if read with an open heart and mind, can influence you on how you view the journey through life.

fritos

Frustrated and not being able to locate the internal pharyngeal nerve, one of my tank mates suggests that I move to a different part of the dissection.  I wasn't making any headway and only making myself angry so it seemed like a good thing to do.  The clavicle needed to be removed.  So I traded scissors and delicate dissections for a bone saw.  Actually, it's more like an autopsy bone saw.

I grab the saw and it makes short work of the collar bone.  You can imagine that in cutting bone, some dust is going to be given off.  And you can also probably imagine that with any power saw, friction is going to generate heat.  Apply friction and heat to a body tissue which generates a dust, and you can imagine that a smell is going to be generated.  I'm here to tell you that it is NOT a pleasant smell.  The murmuring of students over the hum of various saws suggested that it smelled like Fritos chips.  Not sure about that.  If chips ever smell like that, I wouldn't feed them to my dog as a punishment.  Maybe a batch of Fritos chips that have gone horribly awry in unholy ways.  It made one of my tank mates queasy.  I doubt that she'll ever eat a frito pie in her life again.

beauty

I never would have thought of a pathology report as beautiful.  But when it's applied to my brother's tonsils, sweeter brevity could not be imagined.

a bright spot

With everything going on in my life - med school, family, dealing with my brother's cancer - I haven't spent much time tending to my garden. The heat and dryness of summer along with the relentless march of weeds has left much of it looking pretty ragged. In some real sense, that's a very good representation of how I feel. But despite it all, there are a few bright spots. During a study break, I mowed the lawn, drank a beer or three and just sat observing this Cassia corymbosa. It's loaded with flowers and ever since I planted it, I've been rewarded with a steady stream of yellow sulfur butterflies. I'd like to think there's some deeper meaning of life to it - the resilience of life, maybe. Maybe not. But all that I walk with is a brief respite where everything in life just halted for a moment and I could breathe.

omens

About thirty of us are sitting in a waiting room not unlike a doctor's office.  Surrounding us are 14 exam rooms where awaits our first patient as medical students.  Rather than unleash us on actual patients, the medical school lets us make our mistakes on trained actors.  The coordinator calls out our room assignments and partner.  Then a british voice comes over the intercom informing that the group before us has 5 minutes and they are to exit the room.  It makes me feel like we're on a British Airways flight.  Then it informs us to proceed to our room.  Ours is lucky #13.  On the outside of the room is the patient's "name".  I kid you not.  The name was Ms. Robinson.  My partner and I both turn to each other laughing and enter in.  She fulfilled the role of her namesake well.  From a place of maturity, she tutored us in our art and gave us our first taste of that doctor-patient relationship.  It was wonderful.

a mother's prayer

These are my mom's words that she wanted posted.  I just typed'em for her.

August 27, 2010
     It is my birthday today and I'm sitting next to my beautiful boy's bedside at MD Anderson.  He has just had a tonsillectomy, and we are praying they aren't malignant.  Please God, please God.  When I first walked in and saw him he looked so pale and still - my heart lurched - oh God please let him be OK - the fear of losing him is so overwhelming at times, I just want to lay down and die.  And if only I could give my life for him I would of course.  It doesn't work that way.  I need to be here for him.  I need to be strong but dear Lord it's so hard.
     But leave it to my Joshua who is just coming out of anesthesia.  His eyes flitter open a tiny bit and he whispers "Happy birthday" to me.  He, who is facing the battle of his life, remembers to wish his mom a happy birthday!  I stuff back tears and say, "only you sweetheart, keep thinking about others before yourself" and then you ask if anyone has talked to the kids.  Again, your unselfish nature, undiluted by anesthetic, comes through.  This is my Joshua, my beloved son, my precious son, where if goodness and loving kindness would only guarantee health, it would be so.
     As I'm standing by his bed, holding his hand, I'm praying, "Lord, please heal him and let him be with us a long, long time...It's been such a short time, please Lord this is so hard."  Then I open my eyes and look at all the old faces in the beds surrounding Josh's.  My heart breaks seeing my son's young face with his beautiful bald head and face with no eyebrows.  Then a little guy, maybe 7 or 8, is being wheeled in with his beautiful bald head, with his parents in tow and my prayer changes to tearful praise.  Thank you, Father.  Thank you for the years we've had.  I beg there will be more, but thank you!  I praise you for the gift of my boys - my three wonderful boys!