Thursday, October 16, 2008

Thanks for the memory...

Thursday afternoons are always the highlight of my week. My weekly schedule normally goes something like this: For about three hours every morning, my entire class (or those of us who choose to attend) sits in a large lecture hall, listening to various professors expound upon the intricacies of their chosen fields. Biochemistry is the designated (and much disliked, in my mind) topic on Tuesdays, Thursdays, and Fridays, while Mondays and Wednesdays are filled with gross anatomy. Monday and Wednesday afternoons are spent in the anatomy lab dissecting out the various structures that were covered in the morning lecture session. As an aspiring surgeon who enjoys nothing more than wielding a blunt probe and pair of small, slightly curved scissors in the battle for anatomical knowledge, I enjoy anatomy a great deal. There is nothing more remarkable than the intricate layering of the various muscles and tendons in the hand and forearm, or profound zigzagging of the brachial plexus nerves, which appear muddled when seen for the first time but gradually yield their own logic when revisited dozens more.

Occasionally, the dissections prove more frustrating than didactic, and yesterday was no exception. My lab team and I were scheduled to observe the abdominal viscera in situ, expose the vasculature of the gut, and delineate the main vessels that branch off the abdominal aorta. We are assigned to cadavers in groups of eight, with four people dissecting at any one time. For this section--thorax, abdomen, and pelvis--we work in groups of four for two hour shifts, with the second group continuing the work started by the first. I was in the second group yesterday and expected to find a colon and a small intestine with vasculature exposed upon my arrival in the lab. Instead I spent two hours sorting through the remnants of Beatrice's (her nom de guerre) bowels, which had undergone quite extensive surgical alteration. The entire colon was missing, with the end of the ileum anastomosed to the cecum, which had been sewn to the rectum (sub-total colectomy?). The previous groups had spent an entire two hours clawing their way through the mess of adhesions that was the small intestine. What was left of the superior mesenteric artery and its branches in the small intestine had been exposed, but there was still a great deal of work to do. So we jumped right in and attempted to find the inferior mesenteric artery braching from the aorta. I say attempted, because we discovered that it had been cauterized and removed in its entirety, save the superior rectal branch. Following that morass was a two hour struggle to expose the portal triad (portal vein, common bile duct, common hepatic artery). We scratched our heads for a hour or so while we revealed branches incorrectly branching off of other braches, which looked nothing like any of the variations that Netter so masterfully depicted. After some oooohhhhs and aaaaahhhs along with the anatomy professor at what we'd found, we concluded that we had another unique variation on our hands, and left the lab exhausted.

I am constantly amazed by the extent to which the body serves as a record of all life's occurrences, from the catastrophic to the imperceptibly minute. I'm not talking about the obvious here--years of smoking, major surgery, traumatic injuries, etc--but about the tiniest of tiny things. My foray into the anatomical variation of the celiac trunk and superior mesenteric artery was the product of an event that began approximately seventy-four years ago, when a few cells migrated a few micrometers in a strange direction during the embryonic stage of development. I doubt Beatrice felt any adverse effects from this event during her lifetime, and yet I, humble student, was privileged enough to discover its record almost three-quarters of a century later. Sometimes being an anatomist, even an inexperienced and occasionally bumbling one, provides the opportunity to play archaeologist for the afternoon.

But I digress. Back to my weekly schedule. Most of my Thursday afternoons are spent in the hospital playing archaeologist of a different sort, sorting through the physical and emotional events of patients' lives as my fellow students and I nurture our nascent interview skills. My group of five fellow students and I have conducted only about ten interviews so far, but we've encountered some fascinating stories. Today was no exception. We interviewed an elderly woman struggling with Parkinson's, once a healthcare provider herself. Despite what appeared to be a slight pharmacologically-induced delay in her cognitive processes, she was sharp as a tack, remembering well and maintaining her dignity and bearings while six rather green medical students peppered her with questions. I was reminded of my grandfather--a truly great man--who suffered from debilitating Parkinson's for many years before passing away about six years ago. So thank you Mrs. X, for our encounter today. Though you didn't know it, talking with you elicited the most pleasant of memories and certainly brightened my day.

Damn, I'm lucky to be doing what I'm doing.

Tuesday, October 14, 2008


Around this time every year, thousands of students, young and middle-aged, throughout the country are considering applying to medical school for admission to the fall class that will matriculate in two years. If they are fortunate enough to attend a college or post-baccalaureate program with a dedicated professional school admissions advisor, such as I did, then they are likely attending meetings on a regular basis to ensure that the important milestones in the process of selecting schools and filling out the AMCAS application are on track. Preparedness at this early stage means two things: planning to take the MCAT in the spring, and writing the first drafts of the admissions essay that will serve as cornerstone of the medical school application.

Preparing for the MCAT is mostly self-explanatory. A certain amount of science must be reviewed and, if necessary, relearned. Achieving the MCAT score that will yield the best chances of admission requires dogged persistence and rote study of the material, no more, no less. Writing a good AMCAS essay, however, is a different story, or more aptly, a consistently evolving narrative. Two years ago, when I was at this particular juncture in my medical career, I found the writing of the essay to be the most difficult task of the whole application process. Medical school applicants are a diverse bunch who find common ground in medicine. Many of us major in biology, but others take less traditional routes--English literature, history, philosophy, dance. The overwhelming majority have experience in some aspect of the medical field, ranging from biomedical research, to relief work in third world countries, to volunteer work caring for the elderly and infirm in nursing homes. And these qualifications are by no means mutually exclusive; the most visible applicants are those who defy easy categorization. A tuba-playing, HIV-researching, comparative literature and biology-majoring student who finds the apotheosis of human existence in the octogenarian whose endless font of stories she taps every Thursday afternoon when she volunteers at her local nursing home represents a typical combination of extracurricular and personal qualities seen in a medical school applicant.

Which is what makes the writing of the application essay such a taxing proposition. The golden nuggets of truth derived from years of academic and personal growth and achievement must be summarized in the cramped space of a meager 5000 or so characters. But, more essentially, these nuggets must convince their intended audience that the applicant's motivation to become a doctor grew out of a fundamental curiosity regarding the functioning of the human species within its set environment, which is really what health boils down to at its core. Which begs a single question: what leads a person down the path to becoming a doctor?

In conversations with my fellow first year classmates, I've found, unsurprisingly, that our motivations are as diverse as our backgrounds. Some are engineers who see the human body as the most intricate of machines, others find themselves enamored of the complex science that underlies the most elemental physical functions. Still more choose to enter medicine not for its scientific offerings, but for the opportunity to be part of the solution to one of the greatest humanitarian issues of our time--the unconscionable disparity that exists in our contemporary healthcare system. Personally, I have chosen to become a doctor for one primary reason--the opportunity to witness the life and health narratives of my patients.

But that certainly was not the only reason I applied to medical school, which further complicated the essay writing process. If some of my readers here are currently working on their essays and looking for some useful tips, I have one that proved very useful as I fought through numerous drafts on my way to a successful final copy. However you have arrived at your current desire to become a doctor, demonstrate how that process is one component of a consistent evolution. It might be an obvious point, but I'll say it anyway. Expect medical school to change the way you look at the world and interpret the interactions with those who surround you. Roughly six years from now, when you walk across the stage at graduation, you will be seeing the world through an entirely new set of eyes, hopefully one that allows you to better understand your fellow humans--anatomically and physiologically, yes, but also economically, socially, humanly. Let your essay show that you adequately prepared for this evolution, and understand what it entails. The medical profession requires constant adaptation and reinvention. Be prepared.