thoughts about med school

I'm having a really great time in med school. Since I took most of the classes last year, I'm pretty stress free this year. For this current 10 week block, the only new class I have is Gross Anatomy. It's a little overrated, but I appreciate being able to dig around in a cadaver's body looking for all the different muscles of the arm and hand. By the way, in case you're curious, formaldehyde is bad, but the worst part is the smell of the body grease/fat that gets all over you and it doesn't go away until late at night. It's all over your hands usually since your gloves break and the grease get in. If you're curious about the actual experience, post questions and I'll answer to the best of my knowledge.

Anyway, we had a class about giving feedback to our peers. One way PIL works is that at the end of each small group session, we set aside time to give each of our peers and our facilitator feedback. We have to learn how to give good feedback that's useful instead of "criticism." It needs to be construction, not dwell on the past and focus on improvement for the future. It gives you opportunities to confront things that you're not comfortable with and allows you to get over them. It's, of course difficult at first to know what to say or even to be that observant to see things that need improvement. Generally, my group has been pretty awesome. I'm so thankful for them and I feel blessed that I'm making good friends with them.

What else, Clinic was fun last night. We had a patient who had hyperthyroidism and had enlarged thyroids. The patient also had a really high blood glucose and she showed no symptoms. She was pretty interesting and scary at the same time since her BG was so high. My dad's was that high when he suffered his stroke. So whenever I see someone with sugar that high, I always think stroke. We've had other patients w/ blood sugars just as high in the past and we've sent them to the ED because they had symptoms, but this person did not so we administered insulin, gave her meds and sent her on her way.

Today we had a lecture on abuse and maltreatment of minors. They taught us that the abuse comes in cycles consisting of an abusive period, a "honeymoon" period and a silent period and it repeats. And also that abuse and maltreatment doesn't necessarily mean physical or sexual abuse, it could be intimidation games or neglect. That it's always the right time to approach someone about a suspected problem, because they may not be alive the next time you see them. The best way to help people is to make it so that they can help themselves. I realized that for the longest time when I was younger, I knew a kid who was scared of talking to adults b/c of problems during childhood. It took him a while to get over it. He just had an inexplicable fear of speaking and communicating w/ adults. But when it comes to interacting w/ his peers, he was OK. He got over it when he started working at a place where there were older people there and he just got practice interacting with them.

My first exam is on the 14th and 15th of September. It's the midblock exam, 5 weeks into the first block.

first standardized patient session

We had a standardized patient (SP) come in today and we interviewed her as part of our normal case study. So instead of reading about a case on paper, we got to interview a real person. An SP is someone who is trained to act like a real patient. They're actors who come in and pretend they have some sort of disease and we interview and eventually do a physical exam and they would respond to our questions as a real patient would. They would show discomfort if we make them uncomfortable and just behave like a real patient w/ real problems would. It's really fun.

Ours had some sort of arthritis in her elbow and hands and we noticed after the interview and getting the paper case that she was right on on most parts of the case except for 1 detail that she got wrong. Overall, she was very convincing and we had a good time in our first interview. She even kept opening and closing her hands as if that movement provided relief.

It was difficult to get a good flow going with 4 people taking turns to interview. The first person definitely had it easier in terms of flow and what to ask. I guess we'll try to plan out topics to cover better for next time and use our Time Out's more efficiently. We get to call Time Out anytime to discuss things w/ the student who's sitting in the interviewer's chair.

It's definitely difficult not knowing enough about history taking to know what else to ask. We kept asking for more info about one issue she was having and it just became repetitive after a while. And we asked A LOT of open ended questions and only near the very end did we start to get specific.

In terms of comforting the patient, we did the very basics, we didn't really touch on issues such as how her medical problems are affecting her work and family life, which we later found after reading the paper case that it did adversely affect it.

Don't get me wrong it was definitely fun and informative and useful. It was really helpful to have the SP there to practice on. It was also really helpful to have a physician there to talk us through it when we got deer in the headlights syndrome.


So when an SP comes in we have to dress in professional attire so here we are. I should've taken one w/ the SP and our physician facilitator. Oh well.

Dad is staying in Socal for now, maybe he'll move here later in the year, I'll have to find a new place at that time. We'll see how it goes.

the toughest part about medical school

...may not be medical school. My brother and I are having issues concerning my father. My options are mostly bleak and not very attractive. I've come up with one solution that seems perfect if it pans out, but in life rarely do great ideas come thru without any hitches. In all cases, I need to make a decision fairly soon.

I have a quiz on Tuesday, it's mostly review so I'm not too stressed. I'm thankful the the PIL program is mostly review right now. That is it's mostly microanatomy, which I took last year.

They asked me to be coordinator at the Chinatown Clinic and I think I'm going to take the job. It's not actually a job, because I don't get paid. But it should be fun, leadership position and all.

Hope ya'll had a good weekend and I'm sorry if you didn't.

2nd day, Brisbane, Australia

Back for more. My brother arrived the morning of the 2nd day after a direct flight from San Diego. We head out to an animal preserve where we are going to see koalas and kangaroos!



The place is called Lone Pine and it's by a river. Alright that sentence was really awkward, but moving on.


My first encounter w/ a kangaroo. There were a ton of kangas there just lounging around. There weren't that many hopping to and fro but when they did it was pretty cool. I mean you've seen kangaroos hop on TV and in the movies but to see it in person was cool because it's so different from any other animal you've ever seen, well except maybe for bunnies...



We also saw a couple w/ joeys in their pouches. That was cool, no joeys outside of their mom's pouches though. Joey, that's like a baby kangaroo and a pretty good word for scrabble!


There were also emu's there, this one's about as tall as me standing up. Unfortunately the thing just kinda sat there looking at us weird.






I'm sure you're dying to see the koalas, we were too, until we actually saw them. Koalas are very lazy creatures, they just sat there sleeping. We thought they were dead. But they weren't, they're just super lazy. They also had a couple of koalas there that were the products of artificial insemination. That was pretty cool.


Then we came across this chubby little monster. Anyone care to guess what it is? Give up? Click here for the answer. And here for a mug only a mother could love.


We also saw these two dingos there. They were both white and they were brothers. There was a zookeeper there trying to train them. Apparently they have a intense fear of ropes and they wanted to use the ropes to hang food off them during feedings. So the guy walks in and sits down in the middle and lays the rope nearby and takes out pieces of raw chicken. The dingos approach cautiously but never get close enough to the rope or the chicken. We sat there for a good 20 minutes waiting for them to get comfy enough to take the food from the trainer's hands. But they never did. The one you see here is the calmer one, the other brother in the cage next to this one was walking around the cage in an agitated way. They were really cool looking dogs.



These are a couple of the artificially inseminated koalas, apparently a first or something.


This parrot was interesting. There were a few, but we talked to two. The first one just kept saying hello when you tell it hello. It left, apparently bored as we were. The second one was more interesting. It doesn't say hello. In fact it said nothing the first couple of minutes. It was my cousin and I there and his mom called us to leave, so we walked away while saying goodbye to parrot #2. But then we hear this parroty "Goodbye." We turn around and we try to get it to say goodbye again but it wouldn't. Instead it goes "Scratch, scratch." Well what is an American to do when a parrot asks for a good scratch? You scratch. When we stuck our finger between the bars, it held its head closer to the cage. I guess he's had other suckers...err tourists scratch it before and it knows the drill. So we give it a good scratch, we pull away and it goes "Scratch, scratch." Talk about pavlov's parrot! We scratched him and we left and it gave us a nice "Goodbye" as we walked away. That was worth the ticket to Australia! I actually took a sideways video of this, but too large to post.


Artsy picture


We're far from home!


After that we went to Chinatown and found these. I'm not sure that was appropriate after the day we had. At least they didn't have any stuffed white parrots...

After that we went home and chilled there the rest of the night.

dad issues

I guess my dad is a bit jet lagged because according to my brother, he keeps getting up at midnight to go to day care. I told him to take melatonin before bed to regularize his sleep/wake cycles. Hopefully it works. There were other issues of forgetfulness that he's having and I have to talk to him and convince him it's worth him remembering to do stuff like shut off the lights, close the doors, shut off the faucets, etc. I know he can do it, it's just that vacation screws him up and makes him forget to remember to do these things. That's why it was important during the vacation for him to keep doing things to take care of himself, which I confess to doing some of that for him. Funny thing is, I can't talk to him because he broke a cover on his cellphone and the battery wont stay in so, we'll have to get that fixed.

PIL today

We had a good small group today. Another girl and I presented our learning issue which was on the meninges and the myelomeningocele, which is the sac of neural tissue that sticks out of your lower back if you have spina bifida. We created a lot of good discussion and question and answering during our presentation. Similarly, everyone else did excellent presentations and for most of us everything just snapped into place. A large part for me was the preparation that we did which was, for me, more substantial than the other days of small group. On friday, we'll start a new case (each case lasts approximately 3 small group sessions and there are 3 sessions/week).

I have clinic later today and I'll get to see the 1st years I met last year who are now 2nd years and also my old classmates from last year.

1st day, Brisbane, Australia

I went to Australia for two weeks w/ my family to visit my aunt, uncle and cousin there. I took my dad. It was his first vacation in decades! When he got back, he said he loved it. I think I found that I really love my dad on this trip. I never really had that feeling before, now I do and I hope he sticks around for a while, I'm sure he'd like to see grandkids...

Anyway, first day. Australia is divided up into states, about 6 or 7. On the eastern coast there is New South Wales to the south and Queensland to the north. Sydney is in NSW and is quite a ways south, so much so that the weather is very different from the more tropical clime of Brisbane, which is in Queensland (QLD), 12 hours north by car.



Brisbane is a coastal city w/ a river that snakes into the middle of the city. You can get to different places by river cat, a boat that drops you off at different points in the city as the river winds through it.


It's a pretty picturesque city, except for the cloud cover during our outing. It was fun seeing my family and my cousin again.


Anyway, not much happened that day, we went back home and shopped groceries and I picked up this beauty, a custard apple. It's got little custard things inside w/ seeds in the middle and there are a thousand of these little custard seed things. You just kinda suck the meat off the seed and move on to the next. It was really delicious.

Oh we also had kangaroo meat for dinner. It was pretty good, different but good. I already forgot the taste actually so I couldn't say for sure. It just tasted like meat more or less.

We came separately, my dad and I from the rest of the family. One group came a day ahead and my brother came the day after we got there. My brother would arrive the following morning. Stay tuned for day 2 w/ Koalas and Kangaroos.

I separated the albums by city, so each album has different days, the Brisbane one can be seen here: Brisbane Album

gross anatomy

My teammates and I began dissection of a cadaver today. We started on the back. We skinned the poor guy and peeled back each layer of muscle. We didn't finish so we'll have to come back and peel back more muscles. It was pretty neat and by far my favorite part. After a while, cutting away skin and fat from muscle became like cleaning meat that you would cook at home. Morbid, I know, but really that's how I got it. Can't cut into the muscle or you're gonna waste precious food. Ok ok, I'll stop. The two hours we spent with "Charlie," the name we gave our anonymous cadaver, went by quick!

I also had a clinical skills introduction lecture. That's where we learn how to interview patients for history and later, we'll learn how to do physicals. That should be fun fun.

I'll work on the Australia trip report soon as I can, w/ pictures!

Oh I had my white coat ceremony last Friday. I guess I'm officially a med student now! Don't feel any different though...

first couple of days of medical school

I just finished my second day of med school. It's been weird. There are 2 curriculums at Drexel. The standard one that everyone goes to by default and a majority stay in is called IFM. There you get lectures and notes given to you and all you have to do is memorize/understand those notes and you succeed.

The other curriculum is called PIL, program for integrated learning. In this program, you work in small groups of 5-8 people w/ one facilitator, who is faculty. Their job is to steer you in the right direction should you go into a specific topic and it is irrelevant to the case at hand. So in these small groups, you work on case files, which are patients who have problems. The whole case has been broken down into 8-9 pages of stuff. The first page may be the initial consultation. The second page may be history and physical exams. What we do in small group is explore the case in a clinical way (to get a diagnosis) and a basic science way (understand the science behind what's going on). We create learning issues that we go home and research and study and present during the next small group session. Then we discuss and learn (hopefully). We also repeat previously studied/discussed topics in future cases (hence integrated learning) so ideally you reinforce yourself throughout the year. You still get lectures, but they're minimal and usually cater towards the learning issues we've formed. So I'm in this group. We end in April and then we get to do a Primary Care Practicum, where you work along side a primary care provider and try to reinforce what you've learned throughout the year.

So that's that. I'm dissecting a cadaver tomorrow, we're going to open up the back, take out the major back muscles (traps, lats, splenius, rhomboids, semispinalis, erector spinae) and examine each one, what they do, how they do it, examine the spinal cord and vertebrae.

It's been a long day, I have mixed feelings about PIL, but I think I like it! We'll see how the year goes.

Australia pics partially up

Hi all, I finally had some time to sort through most of the pics and have uploaded some of them to my web album on picasa. The ones that are up are taken in Brisbane Australia. Trip report to come later. Enjoy:

http://picasaweb.google.com/henrysiem

ps, Drexel orientation starts tomorrow

pps, the puppies you see are for sale, leave your email address in the comments section if you're interested in buying one