The 12 Days of Christmas?

On the twelfth day of Christmas, med school gave to me. . .
12 hours of studying*
11 respiratory small groups
10 reasons to love the people I study with
9 causes of metabolic acidosis
8 general anesthetics
7 minutes for a glorious shower
6 gabillion reasons not to smoke
5 cups of coffee
4 characterizations of asthma
3 annoying roommates* who are all doing way less work than me for finals
2 interstitial lung diseases
and motivation to really enjoy my holiday vacation!


*12 hours of studying. . . if only, I studied 19 hours straight yesterday and still bombed my exam this morning.

11 respiratory small groups:
(1) Patterns of pulmonary dysfunction, (2) Pathophysiology of gas exchange, (3) Pathophysiology of ventilatory control, (4) Case-based questions, (5) Acid-base disorders, (6) Obtructive disease, (7) Interstitial lung disease, (8) More case-based questions, (9) Pulmonary circulation, (10) Even more case-based questions, (11) ARDS and respiratory failure

10 reasons to love the people I study with:
(1) Micah's mnemonics (I Smell Diarrhea Now- inhaled anesthetics), (2) Julie's hugs, (3) Listening to soothing ocean sounds or choral arrangements, (4) Caramel corn, (5) We rock acid/base disturbances, (6) I taught antibiotics, (7) and Micah taught me basically all of pharm- thank goodness he has asthma, (8) "Hey guys, lets play a game where if quiz eachother and if we get a question wrong, we have to take off an item of clothing."- although I'm not sure strip-studying will ever really catch on, (9) "We can do this, we'll get through it." How we all encourage eachother when we have breakdowns/panic attacks, (10) If I didn't have them, I would be (even more) socially special-ed and a pathetic excuse for a human being

9 causes of metabolic acidosis:
(1) Diarrhea, (2) Sepsis, (3) Cardiopulmonary arrest, (4) Renal failure, (5) Hepatic failure, (6) Diabetes, (7) Carbonic anhydrase inhibitor diuretics, (8) Hypotension, (9) Overdose of ethylene glycol

8 general anesthetics:
IV agents- (1) thiopental, (2) etomidate, (3) propofol, (4) ketamine
Volatile inhaled agents- (5) isoflurane, (6) sevoflurane, (7) desflurane
Anesthetic gas- (8) nitrous oxide

7 minutes in the shower:
(1) Get warm, (2) Shampoo- lather, (3) Rinse, (4) Condition, (5) Soap up, (6) Rinse, (7) Stand and wish I had something else to do in the shower so I wouldn't have to get out of the steam and go study

6 gabillion reasons to not to smoke:
It will kill you.

5 cups of coffee:
(1) Holiday gingerbread spice, (2) Breakfast blend, (3) Hazelnut at Panera, (4) Microwaved after sitting in the pot all day, (5) Consumed all in one gulp of desperation at 2am

4 characterizations of asthma:
(1) Airway obstruction, (2) Hyperresponsiveness, (3) Inflammation, (4) Remodeling

3 annoying roommates*:
(1) Jess, (2) Sarah, (3) Sarah
*But I love them anyway

2 interstitial lung diseases (the 2 most prevalent):
(1) Idiopathic pulmonary fibrosis, (2) Sarcoidosis

And a relaxed, wonderful, real break.

Merry Christmas!!

Young Female Chronically Behind in Life

My little sister's AIM away message is "Hooray for massages and underwear". Should I be worried?? Probably not. She really isn't so little, turned 20 (OMG!!) in October. Geez, that makes me 23.

Being 23 is alright. What is a slightly disturbing thought for me is that so many of my friends and peers are a much, much older 23 than I am. We all started out even at the starting line after graduating from college, but as I look ahead, I realize that I will fall farther and farther behind in the race to adulthood. One of my good friends got married last July, has a home, a steady income, and is on her way to having a son sometime this spring. My single status is a whole other "mixed bag of worms" (as Mrs. C would say), so, ignoring the fact that marriage and babies are not part of my foreseeable future, it will be a minimum of 7 or 8 more years before I will be looking at a steady income. And that will put me at 30. 30 before I am a financially-independent adult!

Example Case:
S: A.M., a 30 yo female with a past history significant for a BS in biology and 10 years of post-graduate education presents with only one additional degree and a lingering dependence on her parents. While A.M. does not still live at home, she requires significant financial support, her love-life is dismal, and she is still on her family cell phone plan.

O: A.M. appears slightly haggard, but in no acute distress.

A: Patient presents with chronic inability to move forward in life. Given her biology degree and past educational success, medical school is a likely diagnosis. PhD training is possible due to the presentation with some financial difficulty, but the extremely lengthy course makes this less likely. MD-PhD training also possible, but would amazingly show an even lengthier course of lingering life immaturity. It is unlikely that A.M. pays her bills, owns her home, has a job, is part of a stable relationship, or is considered traditionally successful.

People pat you on the back, congratulate you for entering this supposedly elite medical field, tell you how proud they are, but what they don't realize is that you are sentenced to be 10 years behind your peers. No wonder physicians are well paid-- besides the extra years of very expensive schooling and accumulation of debt, they also are that many years behind in bringing in money. Our black (should be red really) hole is twice as deep.

P: Remind A.M. that she was (and still is) not ready for marriage, family, and "Honey, I'm home," and that was one of the reasons she chose medical school in the first place. Ensure her that she will love her job when she finally gets there someday.

(*S= Subjective; O= Objective; A= Assessment; P= Plan-- the traditional way to write up a clinical case)

Unite for Sight - Hyderabad, India

My friend Yasir made a video of my trip to Hyderabad, India, this summer. It's a fun recap, and it makes me miss our crazy month together!

"A Toshiba. . . Niiice."

I read through my last few blog posts, and I realized how depressing they are. So, today, I am going to prove that I do occasionally get up on the right side of the bed. This morning, I'm not so sure it was right or left, so much as the fact that I crawled out of bed at 10am. I got a glorious 8 hours of sleep. (You did that math right. I didn't go to bed until 2 last night.)

After a terrible weekend of hematology studying (and me being a crabby witch all day Saturday), I took my final exam yesterday. And although I may not have passed with flying colors, I probably passed. At this point, my only concern is doing well enough to make sure I never have to take that class again. And since then, life has gone swimmingly. (Isn't swimmingly a great word?) I have a lot to write about, since I actually did something other than study.

I woke up yesterday at 6am after about 4 hours of sleep to cram in a little more hematology before my exam, and my friend calls me (he's awake studying too), so we can study together at that ridiculous hour. On my way out the door at 6:15, I can't find my cell phone, even though I was just talking on it. No big deal, I won't need it until later anyway. So, I come after my exam, and I still can't fine my phone anywhere. I'm starting to panic a little, when I decide to make myself lunch and look later. Then, Lo and Behold, there is my cell phone. . . in the silverware drawer. Nope, I can't explain it either.

At that point I tried taking a nap, but I was in a state where I was too tired to sleep. So, instead I went grocery shopping and baked a cake. I have now decided that I should never try to bake while comatose. There should be a warning on the Betty Crocker box-- "Do not operate heavy machinery or a hand mixer during extreme fatigue". I was planning on making a Coffee-Toffee Cake with Caramel Frosting (recipe from the Betty Crocker website) to use up some extra milk-chocolate toffee bits I had in the cupboard.

The actual cake-baking portion went fine, but it was the frosting that ended up being too much of a challenge for my sleep-deprived brain. In my tiredness, I had forgotten to get the caramel topping at the grocery store, but I think, "No problem, I'll make a cinnamon frosting instead". I should have just left well enough alone. In my zeal, I also decided to add a little extra vanilla flavoring to the tub of pre-made vanilla frosting I'd bought. Only, I grabbed the wrong little red-capped bottle. When I'd added my teaspoon, I noticed it was clear instead of brown, and definitely did not smell like vanilla. It was almond extract. Not too bad a mistake, except for that I don't like almond extract. Adding the cinnamon flavor was bad enough, and the almond just tipped the whole precarious flavor balance over the edge of reason. After sprinkling the toffee bits (the point of this entire endeavor), I ended up with a coffee-flavored cake (yum), and vanilla/cinnamon/almond/toffee/chocolate frosting.

It isn't terrible. It tastes like the decorations at Cleo's (a bar on the Ave) look-- too much tinsel, too many lights, gaudacious, but surely not boring. I had plans to eat dinner with some of my guy friends, and luckily, they aren't too picky.

After I finished combining that confetti of flavors, I finally took a much-needed nap. I even had good dreams :).

Then (and Kyle will yell at me for not telling this first, since it is obviously the most important thing I did yesterday), I bought a new TV. It is a thing of beauty. . . at least compared to our old TV. Now, our old TV is truly old, formerly belonging to my grandma. And no wonder she was so willing to give it up. It's a white, 20" monster with a built in VCR. The cable connection in the back of the TV is bad, so we could only watch for about a minute and a half without having to get up and wiggle the cable cord around to fix the fuzziness/static/blue screen. Last week, the connection to the DVD player started to get temperamental as well. . . That was the last straw. So, still in my pajamas after my nap, I drove out to Best Buy. Now, $300 later, I am the proud owner of a shiny, new 27" flat screen (still a tube TV, but wonderful all the same). The guy who helped me load it into my car even commented, "A Toshiba. . . niiiice." Gotta love the nerdy employees at Best Buy. I got everything hooked up this morning and happily watched Martha Stewart in all her 27" glory.

I then ended my evening eating pesto bow-tie noodles and crazy cake with the guys, drinking beer, and watching clips from Jackass.

What a great day.

And it just continues. I took a personal day today. Skipped all my classes, slept in, and now I'm drinking wonderful coffee from Panera, while pointedly avoiding starting the reading for the classes I skipped this morning. I haven't felt so good in a long time.

Screw hematology

I have my hematology final on Monday. And THANK THE LORD because then my misery will end (or at least lessen). I think I actually would enjoy hematology if I didn't have to learn all of it in a month. Three four-hour sessions a week is just plain too much in too little time. Twelve hours per week in a 3 credit class. I have spent so much time on hematology that just looking at my binder triggers my gag reflex.

I was thinking last night as I was studying for my weekly Friday quiz how much I hated my life. Now, a person should only hate their life one night in a row. Which means, despite the fact that I have a final on Monday, that I am going to spend my Friday night like an undergrad. Hallelujah.

However, I still have to study until dinner.

My advice to all of you contemplating med school-- Think hard about it. Really hard.

No positive twist at the end today. I don't have the energy for positivity. Just pass me a beer. (No wonder a large percentage of physicians are also substance abusers. We are driven to it by our education. Don't you think that says something about the system??)

Dinner and a Movie. May it rest in peace.

I just got done watching Grey's Anatomy. (Yes, I do watch, and love, Grey's Anatomy. I think George and I are soulmates.) Meredith just told McDreamy and the vet that she is NOT going to choose. She is going to try *gasp* dating them both! I feel as though most people would read that sentence as "*gasp* dating them both!" However, my mind emphasizes "*gasp* dating them both!" Meredith was right, the concept of dating (at least in my experience) is pretty obsolete.

Katie and I have discussed this, and we both have noticed the death of the date. Not since highschool has someone called me (on the phone, no AIM, e-mail, or dreaded facebook) to ask me if I might enjoy dinner, or possibly a movie. (In highschool, I think we may have even spent a little time in the Funset Boulevard arcade after the show. It was a different era.) Instead, I have been asked to "hang out", "study later", "come over and eat pizza", " 'watch' a movie on the couch", etc. (And actually, none of those things recently, but that's another sad, sad story. It's a dating desert out there.) And, honestly, I don't really mind hanging out, studying, making out while not watching movies, or eating pizza. The problem is that it leaves such ambiguity. Where are you really? Friends? Friends w/benefits? Hooking up? Actually enjoying eachother's company enough to stay together? How's a girl supposed to know?

Sometimes the ambiguity is good. Leaves a little wiggle room. Maybe I don't know if I want to be friends with benefits, hooking up, or starting something with actual > 2-week-term potential. But, I will admit. . . It would be nice, just once and awhile, to gather up my 1.21 gigawatts and pretend it's 1956. I would love to hear of someone, anyone (doesn't even have to be me) having dinner, drinks, and a promising walk-you-to-the-door kind of kiss. Isn't it just a little bit fun to get polished up, then look in the mirror with a little smile and a few stomach butterflies on the edge of something where serious disaster and serious fun are both equally likely outcomes? Aren't we all just a little romantically traditional at heart?

This post is dedicated to Katie K. Us and our men, what are we to do?

Looking Forward

I took my pharmacology test yesterday, and I have a little room to breathe this week. I actually just got back from the grocery store, so I no longer have to subsist on peanut butter sandwiches (made with my roommates' peanut butter) and pickles. (Thought question-- creamy or chunky? Don't answer too quickly, both have merits. Overall though, chunky gets my vote. . . gotta have the crunch.)

I'm in my living room telling myself that I need to start doing my reading at 6pm (It's 5:52) while listening to an mix of Norah Jones and The Fray (a CD my old roommate left in the player). I think the combination of romantic jazz piano and Isaac Slade's attempts at soulfulness are making me pensive. Yesterday, a friend and I were talking about where we would be and what we would do if we could be anywhere, doing anything. I said I would return to Sydney, drink coffee early in the morning as the sun rose over the harbor while editing the latest of my popular scientific/medical articles to be published in Scientific American. The thing is, I don't really want to do that right now. I want to be a doctor. . . But I still could someday. It isn't a dream that far out of reach-- which is encouraging. The first truly encouraging thought I've had for awhile. So look for me in Australia in 20 years.



Damn. 6:02pm. Time to work.

Iatrogenic Disease

Iatrogenic
Pronunciation: (")I-"a-tr&-'je-nik
Function: adjective
Etymology: Greek iatros physician + English -genic
: induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures (an iatrogenic rash)

Ugh. My social life has iatrogenic disease, and school is my iatrogenic rash. Being a second year student is rough sometimes. Nothing is that hard, but there just aren't enough hours in the day to learn everything while also doing normal-person things like exercising, showering, and grocery shopping. So, needless to say, it's been awhile since I've written anything on here. (Since my last entry three weeks ago I've had two midterm exams, one final, five quizzes, one write-up, one clinic day, and a partridge in a pear tree.)

Unfortunately, seeing as its already 12:20 am, and I only got 4 hours of sleep last night, this is going to have to be brief as well. Good thing not much exciting happens when all one does is study.

Amy's life occurrences in a nutshell:
- I got a new wallet and credit cards.
- Congrats to Curt and Nate for surviving IronmanWisconsin, and to Curt for qualifying for Hawaii! I watched the beginning of the swim, it was great.
- My grandma had major eye surgery (she's going to be using one of the eye prostheses I learned a little about at LV Prasad in India)
- Iowa State broke my heart by losing to Iowa 17-27 in Iowa City. (Good thing I'm no fair weather fan!) But I did win a T-shirt door prize at the ISU Madison Alum Club gathering. (Yes, I went to an ISU Madison Alum Club gathering.)
- Dealing with stress by shopping (mainly online, for shoes)
- Holla for drinking beer while studying
- I received a Facebook message thank you for a wedding gift I gave! (Emily Post would be displeased-- what is this world coming to??)
- I went to a wedding (different one from the facebook thank you gift) where the husband took the bride's name. Interesting.
- Mom came to Madison to hang with me for the afternoon and share her infinite wisdom with the members of the UW Women in Medicine group. We had a fun afternoon talking, and Mom makes killer margaritas.

Ok, hoping for 5 hours of sleep if I go to bed now. If I wouldn't procrastinate so much, I'd be better off. But it's just more fun to make cookie's for the Dean's Cup (a hard-core competition between the med and law schools at UW) bake-off while watching Project Runway than to study pharmacology. Oh well.

Crocs Rule!

Did you know that Steve Irwin died?? I didn't until this morning. I was reading the Top News stories on my Google homepage when the tragic headline caught my eye. Cause of death-- stingray.

Here's a quote from the Forbes story, "Stingrays have a serrated, toxin-loaded barb, or spine, on the top of their tail. The barb, which can be up to 10 inches long, flexes if a ray is frightened. Stings usually occur to people when they step on or swim too close to a ray and can be excruciatingly painful but are rarely fatal, said University of Queensland marine neuroscientist Shaun Collin. Collin said he suspected Irwin died because the barb pierced under his ribcage and directly into his heart. 'It was extraordinarily bad luck. It's not easy to get spined by a stingray and to be killed by one is very rare,' Collin said. "

Huh. Lucky shot by the stingray.

And what a memorial. . . "At Australia Zoo at Beerwah, south Queensland, floral tributes were dropped at the entrance, where a huge fake crocodile gapes. Drivers honked their horns as they passed. 'Steve, from all God's creatures, thank you. Rest in peace,' was written on a card with a bouquet of native flowers."

http://www.forbes.com/business/healthcare/feeds/
ap/2006/09/04/ap2991321.html

And for more random Steve Irwin, this is a cartoon I found online (http://crap.jinwicked.com/imgs/comics/20040108.jpg) satirizing the situation after Irwin fed crocodiles with one hand while holding his baby son in the other.



Crikey, what a legacy.

Chemical and Physical Injury

The lecture was titled "Chemical and Physical Injury", and here's a few quotations from my pre-reading for the class:

"Specific Objectives. Be able to discuss the following:
. . . 11. Mechanism of death by electrocution and lightning.
12. How to distinguish gunshot injuries at various distances.
13. Definitions, types, and features of the various asphyxiations.
(Morbid, huh. It does boggle my mind a little that I may actually have to someday apply these learning Objectives.)

I. Chemical Injury
A. Ethyl Alcohol (ethanol)
. . . 5. Neurological complications: . . . The combination of cerebral atrophy and intoxication predisposes and alcoholic to intracranial subdural hemorrhage from ground level falls.
(This is the fanciest way possible to say, "drinking kills your brain cells, and when drunk on top of having a small brain, alcoholics easily fall over and seriously hurt themselves.")

G. Cocaine
. . . Rectal insertion of crack (butt crack) is also an effective means of cocaine administration. While there are no good studies on bioavailability regarding this method, anatomic consideration support this as an effective route. . .
(Huh.)

II. Physical Injury. . .
B. Sharp Force Injury
. . . 3. Chops: A chop (axe) wound may also be categorized as a type of sharp force injury. These injuries often combine elements of blunt and sharp force trauma. An example of this is an incision and fracture produced by an axe blow to the head. . .

G. Environmental Hypothermia
. . . 3. A unique feature of deaths due to hypothermia is paradoxical undressing. Near death, an individual may experience burning paresthesia and subsequently take off clothing. This is often very confusing to uninitiated death investigators. . .

H. Asphyxiation (Adult content here)
. . . 5. Autoerotic asphyxiation: A unique form of asphyxia occurs in the setting of self-induced hypoxia during autoerotic activity. Orgasm is reportedly heightened by non-lethal hypoxia. In fact, many volunteers in the blood-pressure-cuff-around-the-neck study indicated a degree of pleasure from the experience. . . Because of the short duration needed to lose consciousness, individuals engaging in this activity are at risk for death. Do not try this at home."
(Say what?!? First-- who would volunteer for a study where you get a blood pressure cuff put around your neck. And second-- I think I will make a point of never trying this at home.)

Uranus is Next

"After a week of contentious public and private debate, a small cluster of astronomers has voted to demote Pluto from its planetary status. Rejecting an expansive definition proposed by a special committee, the astronomers of the International Astronomical Union (IAU) defined a planet as: a celestial body that orbits around the sun; has sufficient mass to become round; and has "cleared the neighborhood around its orbit." On the strength of puny Pluto's inability to dominate nearby Neptune, whose orbit it crosses, as well as to clear out the Kuiper belt of many Pluto-size objects, it fails to qualify as a planet under the new definition. "
"Astronomers Relegate Pluto to Dwarf Status." ScientificAmerican.com

This just rocks me to my elementary school core! Imagine how many mobiles, styrofoam dioramas, and tri-fold poster board science fair projects are now obsolete!

My friend Nick wants to make Save Pluto T-shirts in honor of the ice ball getting demoted to JV status in team solar system. We debated about the saying on the back--"Uranus is next" beat out "There's a hole in my soul-ar system."

I'm currently at Atlanta Bread Company procrastinating while I should be reading about colorectal cancer. I had to stop looking at pathology slides because the internet site went from ok to slow to really slow to "This page cannot be displayed." So I'm wasting time nerdily reading the Scientific American website until 3pm when I need to call Badger Cab to see if they found my wallet. (I had to borrow $10 from my roommate to get lunch today. Not having money, driver's license, credit cards, or your student ID makes daily life a challenge.)

Opening Remarks

I dedicate this blog to Julia who needs more to do at work, and apparently enjoys reading about me!