Tuesday, August 30, 2011

Gross Anatomy Test

On Friday we had the first anatomy test. Don't you find it ironic that the name of the course is Gross Anatomy? Where was the ambiguous specialist on the day they chose course names? The smell kind of punches you in the nose when you first walk in, but it is still the burning eyes from the embalming fluid when you get close enough to identify landmarks that I dislike the most.

Anyway, I tried studying this week at school instead of at home and I found it much easier to focus. Every morning Chiara asks where I am going and now she tries to come along with me. She is so funny how she just assumes that I am going to take her on my bike every morning just because she says, “Bye, Mama!”

The test was on Friday and I woke up at 4:30 am to an apocalyptic rain storm. Car alarms were going off but you couldn't hear them over the rain.  There is no air conditioning in Oregon so we sleep with the windows open. I hurried to batten the hatch down and wondered whether the specialists were mistaken on which side of the United States the hurricane was supposed to make landfall. I expected fish to be swimming outside our window with rain so torrential. That was really the first time I've seen it rain in Oregon.

Luckily by the time I went to school the storm had passed and I spent the last few minutes I could studying various details. I just realized that Shelli has never asked and I have not told her what we have been studying and what the test was over. It is the first section of our dissection which includes the superficial and deep back muscles, shoulders, part of the neck, bracchial plexus, pectoral region, arm, forearm, and hand. Specifically, we learned the clinical importance of the bony landmarks, muscles and the nerves, veins, and arteries that supply them. I liked the way we studied anatomy back at BYU better where they gave us a skeleton and we learned all the bones and their marks at the same time, then added muscles, and finally went through each system separately. That was more organized, but would be difficult to do here because we can't dissect the entire body and then put it back together as needed for the systems. So we learn everything at the same time. Truth be told, there isn't a single concept that is difficult in and of itself, but the volume of information that we cover is so large that remembering everything is difficult. Unfortunately, I felt like the day before the test was when I had a sufficient frame of reference for everything that I could really begin learning the details we were covering.

There were two parts to the test: written and practical. The written took two hours and covered a lot of the clinical stuff. The practical was set up in the cadaver lab with two questions per cadaver plus some x-rays, MRIs, ultrasound, and bones set out with identification and landmark questions attached. We had a minute per station to look at the tagged structure, figure out what it was, and write it down. There were fifty questions and we had ten minutes at the end of the rotation cycle to go back to stations we weren't sure about and give it our best guess. After the test, most of the class went out and got drunk and from the reports, remained so until Monday.

We should find out sometime around Wednesday how we did, but on Monday morning our lab instructor expressed his acute disappointment with our performance. Most of the class I have talked to has resented how difficult he made the test. I am not going to complain about the level of difficulty because I feel like we should be expected to identify anything that is tagged and especially those things that we have been told to look out for. I only hope that I can learn how to learn more quickly and to retain longer.

Sunday, August 21, 2011

I Wrote the Title after Writing the Entry

We have our first test on Friday the 26.  I was doing okay at understanding the material until we got to the nerve branches of the brachial plexus and the branches of the arteries in the upper extremity.  Muscle mechanics make quite a bit of sense to me as long as I know where they attach to the bones.  Anatomy can be rather dry but our professors do a great job of keeping it clinically oriented and therefore interesting.  Dr. Benninger is a fantastic anatomist and also has quite of bit of clinical experience and so we also get to learn radiology and imaging on top of the dissections.  In fact, he is convinced that ultrasound, because it is so benign and inexpensive, is the "stethoscope of the future."  Part of the test on Friday is finding anatomical landmarks with a portable ultrasound system he has in the lab.  If Shelli can handle the smell of embalming fluid I think I'll keep my money and tell her the gender of our child myself. :)

Speaking of medical equipment, I just filled my medical bag with the stethoscope, ophthalmoscope, blood pressure cuffs, etc.  Who knew that stuff was so expensive?  Medical-grade has taken on a whole new meaning.  Seriously, a normal stethoscope costs about $120 and the ophthalmoscope set costs almost $500.  There is no sales tax here which is nice and saves about $50 compared to California with it's 9.5% sales tax.  I understand the need for quality equipment and I understand supply and demand curves, but I suspect some designer syndrome (the minute you assign designer status, a $3 t-shirt becomes $120.  That's how it worked with a superman shirt in Pisa.)

I mostly spent the week studying and trying to figure out how to be most efficient.  We are in class from 8 to 4  plus or minus an hour with an hour break for lunch at noon.  I have discovered that I become irrecoverably tired at about 9:00 pm.  It takes me about four and a half hours of study time to prepare for the next day and that includes minimally reviewing what I have gone over that day in class.  So, I either need to increase my window of wakefulness or become way more efficient at studying and preferably do both if I can.  I tried studying at home this week which means I am closer to Shelli and Chiara, but there are so many distractions.  I think this week I'll try studying at school and see if I can become more efficient, but I'm afraid I won't ever see Shelli or Chiara awake.  I guess I'll let you know how this next week goes.

Last post I explained that Chiara has figured out how to work the child protection covers for door knobs.  This week we bought a weapons-grade cover to see how long it would take her to figure out how to undo it.  It took her three days and just this afternoon she brought me the two halves as if to prove her relentless fascination with freedom.  I would have laughed and congratulated her if it didn't mean more work to keep her contained and entertained.

Also on the list of things that I have noticed is that you cannot fill your own car with gas. State Code 480.315-320, find it on State government website: www.leg.state.or.us

"An owner, operator or employee of a filling station service station, garage, or other dispensary where class 1 flammable liquids are dispensed at retail may not permit any person other than the owner, operator or employee to use or manipulate any pump, hose, pipe or other device for dispensing the liquids into the fuel tank of a motor vehicle or other retail container."

ORS 480.385, The penalty for pumping your own gas is:
Civil penalty shall become due and payable 10 days after order: $500.

There are 17 declarations listed which try to rationalize this law.  I don't understand it in these terms, but maybe some natives can correct me if there is any reason beyond economic gain for the "trained and licensed petroleum dispensers."

I've included a few of my favorite reasons straight from Oregon State Code.


1) The dispensing of Class 1 flammable liquids by dispensers properly trained in appropriate safety procedures reduces fire hazards directly associated with the dispensing of Class 1 flammable liquids.

7) Exposure to toxic fumes represents a health hazard to customers dispensing Class 1 flammable liquids.

10a) The significantly higher prices typically charged for full-service fuel dispensing in states where self service is permitted at retail discriminates against customers with lower incomes, who are under greater economic pressure to subject themselves to the inconvenience and hazards of self-service.

11) The increased use of self-service at retail in other states has contributed to diminishing the availability of automotive repair facilities at gasoline stations.  (What does that even mean?)

14) Self service dispensing at retail contributes to unemployment, particularly among young people.

My personal favorite is:
17) Small children left unattended when customers leave to make payment at self service stations creates a dangerous situation.  (I'm not making this up!  Somehow that makes it even more funny.)

Frankly, I'd like to pump my own gas.  During my interview back in January, I was trying to return my rental car with a full tank and catch my flight and happened to find the station at a shift change and waited 16 minutes for the licensed operator to make his way to me.  I didn't move on to another station mostly because my incredulous shock kept telling me that it couldn't take but ten seconds more.

Sunday, August 14, 2011

A New Life

We jumped into things with both feet this week.  The first full week of real medical school was uncannily like any undergrad class.  There was a lot of talk about professionalism and what is expected of us, we drafted a vision statement, and then the real classes started.  It was disappointingly similar.  Somehow, I thought that we would be beyond the fluff.

We started anatomy on Wednesday and got our first taste of the human body.  I took anatomy and studied cadavers at BYU, but this is my first time actually dissecting a human donor-cadaver-patient (the current respectful term.)  I really don't like the smell of formaldehyde and I find that when I get too close it burns my eyes, but so far, I haven't felt any of its potential psychological effects.  I thought that the material would be impossibly hard and it will probably become harder, but most of what we have learned already has been sufficiently covered in undergrad courses and this is a time to touch up on what I have already paid the price to learn.

The amount of material that we are supposed to cover is daunting and even my brushing up takes quite a bit of time.  I can't imagine how it must be for those who have never taken an anatomy or physiology class or who may have graduated in something other than the life sciences.  We have three classmates with PhDs, a licensed chiropractor, and several with graduate degrees.  I've met some from each category and it doesn't appear that any (with the possible exception of the chiropractor who has already taken most of these classes already) can waltz through what we are doing.

On a domestic note, we got moved into our apartment on Saturday and spent what time we could this week unpacking and making a home.  I've included a few pictures to give a frame of reference.  It's 3 bed/2 bath 1100 sq ft and the biggest place we have lived yet.  We are on the ground floor for once, but the benefit of no stairs is offset by less privacy and a noisy family with six young kids living on top of us.

Chiara has discovered locks and how to use them.  She can lock and unlock doors at will with anything that can fit in the slot.  Deadbolts and handsets are no barrier and she has even figured out how to work the child-safe door-knob covers that keep her in her room and out of our room.  Any ideas?  She's relentless.

One of my favorite things so far is that blackberry bushes are taking over the state and they are all ripe right now.  Several times a day Chiara asks to go pick berries.  This bush is just off the road coming into our apartment complex.

A deliciousness that Shelli made out of some berries Chiara and I picked.
Chiara loves to be involved in everything we do.  She saw me treating Shelli's headache and decided she wanted to do some HVLA/myofascial release on her own.

One of my other favorite things about this area is the weather.  'Nuff said.

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