Braaaaaains

This is your brain:

That's what I'll be learning about for the next couple of months.  For about 4 weeks, we'll be doing the anatomy of the brain, brain stem and spinal cord.  After that is spring break (whoo) and then we'll come back to do the "touchy feely" stuff - which is the behaviour / psychology part of the Brain & Behaviour course.

B&B is apparently the hardest course at Penn Med.  Period.  And I thought my last class (MDTI - mechanisms of disease and therapeutic interventions) was bad.  The only redeeming quality is that the material is totally super awesome. 

Unfortunately, it's only been a week and a half and I'm already a few days behind in class.  This is after putting in 5+ hours every day trying to keep up (ok, I completely goofed around the last weekend and did no studying - so maybe that's why, but it was totally worth it!).

Getting slammed by this much information makes me feel kinda small and stupid.  I mean, yes I understand this is really complicated stuff, but my mind doesn't seem to care.  As of now, this is how my brain feels:

Here's something interesting I've gotten out of the last week and a half.  There is a sensory homunculus in the somato-sensory cortex of the brain.  When all of your senses come back into your brain, they are brought back in a very careful way so a map is made of your body.  So if you stimulate your toe, one specific part of your brain lights up.  Stimulate your pinky, a different part lights up.  This map of your senses is called the homunculus:

The brain has a big fissure in the middle that goes from the front to the back of the brain.  The homunculus is approximately the same on the left and right side of the brain (representing the right and left side of the body). 

Speaking of your toe - ever wonder why foot fetishes are so common (actually, I think they are the most common "deviant" sexual practice)?  Take a close look at the medial part of the homunculus - professors joke that it's like your "feet are dangling over the edge into the deep parts of your brain".  Well - there's something else dangling down there too: sensation from your genitals.

Referred pain and crossed information pathways leading to "misplaced" information is not uncommon in the brain.  Sensation from the toes is very closely placed to sensation from the genitals.  So if you stimulate your toes... let's say "vigorously", I can see why some cross stimulation might happen in the genital part of the homunculus map.  It's also possible that some people have an unfortunate (or fortunate, depending on your perspective) cross in neuronal pathways leading to a large overlap in the toe/genitals map.

So there you have it, a possible biological reason why foot fetishes are so common. Am I backing this up with scientific studies?  No.  Conjecture is so much more fun for topics like this.

Learning about brains is so awesome.

I have the coolest sister in the world (+ miscellaneous MDTI thoughts)

The week of Jan 31st wasn't the greatest for me.  I got some bad news from family and then from friends.  But time's always moving forward, so I worked through everything.  Having the MDTI exam on 2/7/11 wasn't something great to look forward to either - it meant the weekend before that was completely devoted to studying.  

But there was a major high point.  My (rakhi) sister AS stayed up till like 2 am Tuesday morning baking me ~4 lbs of brownies and cookies.  She overnighted them to me via FedEx (took me a while to actually pick it up though).  That definitely perked me up.  Here's a shot of what they look(ed) like:

Usually it takes me forever to finish eating baked goods, but thanks to the impending MDTI exam (= stress eating) + studying with LV (= 2x stress eating), the baked goods were all gone in 1 weekend!

Thanks AS - you really made my week and weekend!  You are the best sister ever!

This post was actually supposed to be posted before the MDTI exam, but I (for once) decided to be good and not distract myself.  So it might be a bit odd to put up this post after MDTI ended... but anyway - one of the things we were learning about in MDTI were chimeric proteins.  These are proteins made by combining different parts of different proteins (so they have partial functionalities of all the proteins).  Most of these are very bad ass proteins - like Rituximab which specifically hits B cells, or certain TNF-Alpha inhibitors.  

Now, I know chimeric proteins are supposed to look something like this:

Or this:

But in my head, I always think chimeric proteins are kinda bad ass.  So instead of seeing the shapes above, I see this:

Am I the only one?  I think it's a much more accurate representation of fusion proteins!

On Tuesday (after we partied really hard Monday night to celebrate the end of MDTI) we started Brain & Behaviour.  This is apparently one of the most difficult classes at Penn Med.  But it's also one of my favorite topics in biology.  Somehow, it feels like a Clash of the Titans moment (I'm not really a titan, at all, but you get my point).  

I can't believe how fast time is flying by.

MDTI = FML

I don't quite know how to explain how painful the MDTI exam on Monday will be.  I think this picture does a great job of expressing how I feel:

On top of that, I'm distracted by images like this in my notes:

That, and silly jokes like how URAT1 sounds like a text insult - reading it out as "You are eighty one!" - definitely do one thing: keep me engaged with the subject material.  That's about 90% of the battle after studying for 6 hours straight.  Good times.

I know I'm studying too much when:

1. I haven't played video games in almost a week (rockband counts as a social activity, so I'm not counting that here)

2. I stopped making my bed in the morning.

Hmm, I know at least one person who'll be happy to hear about #1 (hi mom).

(For those of you who went to the Gout lecture - you'll see what I did there...  If you don't, /facepalm)

P.S. - For those who don't know me well: I'm actually not that stressed by MDTI.  It's just something to write about because it is taking up so much of my damn time right now.

No regrets, and why missing class is bad (aka Karma Continued)

I skipped out on a CDM (clinical decision making) lecture last week.

Usually I'm a goody-two-shoes: I skipped class once last semester (that was to go see a patient - I'd say that's a good excuse).  I skipped class(es) once this semester - and this was one of the lectures on the day I skipped.  Ok, this time I didn't really have a good excuse - but hey, lectures are recorded, so I figured I'd look at it later.

And, of course, this lecture had one of the most important lessons I'll learn in med school (thanks Karma): No regrets.  More specifically, it went something like this:

"You can't control outcomes no matter how much you want to.  You make the best informed decision you can but bad outcomes are inevitable. If it doesn't turn out well, you'll feel guilty.  But the thing about making an informed decision - making a good decision - is that you won't (or shouldn't) regret the decision."

At least that's the theory: hell, I'll take it.  (Obviously I paraphrased what the lecturer said.)

This is an extremely important lesson that people need to learn in life, and it goes doubly, quadruply, 1000xuply for (future) doctors.  The "bad outcome" is pretty damn bad in the healthcare field.  So it's that much more important to make sure you make an informed decision.  And it's that much more important to not regret the bad outcomes.

Ok, clearly this is probably not a good decision in the first place, but it is funny. So there.

And of course, Karma did what it's famous for: it always gives 110%.  The professor was talking about how pharmaceutical companies use Willingness to Pay analyses to set drug prices.  At one point he asked "anyone worked in pharma?  As a consultant maybe?" and most of the class (that was there) was looking around to see where I was.  One of the few times my experiences are actually useful for a session... and I'm at the Verizon store upgrading my phone.  (In my defense, I was | | close to throwing my old phone over a bridge.  The Samsung Omnia was great when it came out - before the iPhone.  So in this day and age, it's a really crappy phone).

In reviewing the lecture today (and boy was it an appropriate day to do it... was/am having a pretty bad day), I have to say - Karma was actually on my side for a change.  It's not that I haven't learned this lesson through the school of hard knocks.  But hearing it from a lecturer makes it so... official.

And being reminded that you don't have to regret good decisions (regardless of the outcome) is always nice.

Of course, there's always that little detail: knowing that you made the right decision(s).  I work very hard to make sure I say the right things and do the right things.  I'm a good guy.  But when something goes wrong... I always have this guilt.  I was in control of the situation - or played a big role in the situation... therefore it could have somehow been my fault.  Something I didn't account for.

I know I beat myself up more when things go badly than the average person probably does.  But it's always important to separate the learning experience from the regret.  It's also important to remember that the outcome isn't always in your hands - no matter how hard you try or how informed / good intentioned your actions are.

I'm still working on it.  I'm still learning.

So at the end of the day, do I regret skipping class?  Nope.  Did it have a bad outcome?  Yes (but fortunately: no one died, and I didn't completely miss the boat - yay recorded lectures!)  It was the best decision I could've made at the time (hindsight's 20/20 so it doesn't count).  And since a picture is worth a thousand words (even if the picture is just a bunch of words) - here's how I feel about missing that lecture.  Here's how I feel about (most of) my actions in life:

In other news - my MDTI (Mechanisms of Disease and Therapeutic Interventions) final exam is 1 week from today.  This is the amount of information that will be tested:

I'm not going to let this stand in my way.  I will destroy this material and become the best damn doctor I can be.

Bring it on.

Musings

It's hard to believe that school has only been in session for 3 weeks.  I'm pretty convinced my brain isn't built to handle the amount of information being thrown at us.  The scary thing is - this is how our school is "easing us into" this semester: the next class we take - Brain & Behaviour - is supposed to be a lot worse.  Oh joy.

And yes, I spell behaviour with a u.


At the same time, there's nowhere I'd rather be.  Where else does this happen:

Professor: "So the malignant cells invading into the tissue look like really long tongues digging deep into the tissue"

*We look at each other, start giggling, and then start laughing uncontrollably*

Professor: (initially confused, then looks at the slide, looks back at us and says) "You have really sick minds"

Which makes us laugh even harder.

On the flip side, I'm pretty sure I'll never forget what a malignant neoplasm looks like when it's being... malignant (i.e. invading normal tissue underneath it).

At the same time, this is the same class that gets moved to tears by the Alex's Lemonade Stand story.  We had Alex's parents come talk to us about Alex's experience with cancer and how she set up a lemonade stand to raise funds not to help herself - but to help other kids with cancer.

Alex raised $2000 in one day.

This is the kind of talk that reminds us why we are in medical school - what we are fighting for.  Seeing my class go from giggling at pathology slides to being moved to tears by strong stories is oddly inspiring - I don't know if I can explain it.  Seeing their resolve to plow through this material so they can one day make a difference in people's lives inspires me to stop procrastinating and do the same.

Now I just have to figure out how to break the following cycle and I'll be the bestest med student EVER:

To teachers who are no longer with us

On Thursday, Jan 13 2011 our class heard that one of our Genetics professors (who was also a small group discussion section leader/preceptor) had passed away.  Dr. Thomas R. Kadesch.  

When I saw the email, his name sounded very familiar (we have many, many professors who teach our classes - sometimes just a lecture or two), so I googled his name and saw his picture.  My first response was "he's the guy who taught me about Retinoblastoma"!  He was not my small group preceptor, so I didn't know him very well.  But I did remember almost everything he taught us about Rb (think of that as either the protein or retinoblastoma itself).

Rb is a pretty rare disease.  But considering how many students Dr. Kadesch has taught (in just our year, that's about 165 kids), I'm sure one of us will end up diagnosing a patient with Rb.  I know that if I end up being the one who diagnoses a patient with this cancer, know this: it won't be because I'm smart, or because of any inborn talent of mine.  It'll be because Dr. Kadesh taught me about this disease.  Him and all the other professors who lectured to us about this cancer.   


Good people in the world live on through their deeds.  For teachers, this is doubly true.  Their impact on students continues to help the world long after they are gone.  Thank you Dr. Kadesch.

My condolences to his family, friends, and my fellow students (especially the ones who had him as their group discussion preceptor).

As a side note, as I was writing up this blog post, my music playlist started playing the "Aeris Theme"  (or Aerith if you played the Japanese version) from Final Fantasy VII.  For those of you who know it, you'll understand why it's appropriate.  For those who aren't familiar with it - give it a listen.

Even if you don't know about FF7, I'm pretty sure you'll understand why it's appropriate.

Rest In Peace Dr. Kadesch.

Karma

So, as always, instead of going to sleep - I'm up writing a blog post.

For some reason, Karma's been on my mind the whole week.  As an unintended physical manifestation of my musings (thanks life!), I ended up getting hot chocolate and a muffin at Good Karma earlier in the week, and I had dinner at Karma Restaurant & Bar over the weekend.  I don't frequent either spot (not because they aren't good - they are both pretty awesome actually).

Translated, Karma means action (more aptly, "to do" if I remember Sanskrit right).  I've always believed actions speak louder than words and place great importance in action.  Of course, the pop culture interpretation of Karma is along the lines of "beware what you do, because [karma] will come back and bite your ass".  I don't know if I believe in that - I've never been a big fan of "do the right thing so good things happen to you".  I prefer "Do the right thing because it's the right thing to do".

So why has Karma been on my mind?  It's because I don't know if I'm doing the right thing these days.  School's piling up a lot of work.  That means the precious amounts of free time I have left is spent watching TV / going out to party with local friends.  That means people who are important to me that aren't nearby fall to the wayside: I've talked to my parents once this week.  My (rakhi) sister only once and texted a couple of times.  Let's not even talk about me keeping in touch / being there for my close friends outside my family.  All of this isn't unexpected - I'm in medical school, it's going to be a lot of work and a lot of pressure.  I know it, my family knows it, and many of my friends probably know it and understand as well.  I guess the issue is I'm feeling slightly guilty I'm prioritizing things like TV above keeping in touch with people.

Beyond that, I'm also at a certain crossroads in my life right now (it's got nothing to do with school).  It's a crossroads I've been to before, and I'm pretty sure I'll choose the same path... again... and it is not a fun path to walk (yes I know I'm being cryptic).  And I don't know if it's the right action.

I do the right thing because it's the right thing to do.  But when I'm concerned I may not be doing the right thing... that's when I start worrying about the second part of Karma: that it comes back to smack me over the head.

I just have to remember that at the end of the day, I can only do the best I can.  I have to trust that I've got a strong moral & intellectual compass.  Because the conquest of Karma lies in intelligent action.

In other good news - I started my p90x workout regimen again.  Whoo!