(from www.hivandhepatitis.com)

Everyone is afforded a few days in which they’re completely out of it. I’ve used up half of one this Thursday.  

I knew I was in trouble this morning as I got off the bus as my classmates mentioned we had a small group today. My internal response, “We had a small group?” Somehow that’d never hit my radar, even though I’d looked at the schedule for today and knew there was a lab later in the day.

Imagine that I arrive to the med school at 7:53. The small group is at 8.

By some miracle, I manage to figure out where my small group is and make it there on time.  This would be the week that our small group is being led by our course director Dr. Bill Raszka though.

Ah well. The rest of the day was fine.  

***

Today’s post is more Raszka-centered than normal, mainly because he’s done so much I haven’t written about.

Students love him. (I do too.) The one thing that can get student’s ganders is that he is vehemently opposed to giving answers to case scenarios. He is more interested (rightly, I think) in getting us to understand the reasoning and thought process for a case than in giving us the solution.  ”I have more faith in you medical students than you do,” he told us.

Someone asked him, “Could you just give us a test where there are no answers?”

“I did that with the second-years,” he told us. “They didn’t like it.”

***

Incidentally, Raszka’s to blame for the title of the post. We were discussing clinical tests to determine whether a patient has a disease, and a student responded that you could use an ELISA (enzyme-linked immunosorbitent assay). His response…well, you read the title. That gives you some sense of what he’s like.

I must say he is one of the most animated lecturers I’ve seen since Dr. Everse from CMB. He’ll also walk around and randomly grab people for demonstrations. A day or two ago, he actually randomly went over and dragged three people, one at a time, to the front for a demo.

***

Throughout these two days, we talk about immunization theory and practice, clinical immunology tests and autoimmune diseases. We also go to the gross specimen lab and look at tissues with acute and chronic inflammation, including a consolidated (i.e. solidified) lung and a cirrhotic liver.

And then, off to a full weekend of studying for the big exam on Monday….

***

(from saveyourself.ca)

 More lectures on the immune system today. Today we’re talking about two types of cells in the immune system: T-cells, and the cells we’re focusing on today, B-cells, which are responsible for producing antibodies in response to an infection.

Fairly straightforward. But who knew it was really all about love?

The B-cell, you see, is made in an immature form in the bone marrow, made specifically to recognize a specific part of an antigen. (An antigen is something that sets off the immune system, like a foreign bacteria.) If the B-cell finds that thing, it will then become activated and divide into new cells.

Dr. Raszka decides to frame the B-cell story in his favorite metaphor: romance.

He explains that the B-cell’s search for its antigen is like someone looking for its mate. When it finally does, he tells us, the B-cell can get so excited it found its mate that it makes lots of babies, i.e. it makes lots of clones of itself.

Alternatively, the B-cell might become a memory cell, which remains inactive until it finds the antigen again (i.e. when the person becomes infected with the antigen again, like when you get another bacterial infection), and then it will make clones of itself.

Or, as Dr. Raszka explains it, “It’ll say, ‘That’s pretty cool, but I’m not really in the baby-making business. I’m just going to hang out. I’m never, ever ever going to forget you.’…And it’s going to reside someplace so the next time you come by, it goes, ‘Hey, you’re in town!’” 

However, because of how B cells are made, some of them will be made to recognize things that exist in YOUR OWN BODY. This is a BAD thing., since it’d mean your immune system would attack your own body.

So how does the body prevent that from happening?

The body can send signals to make that B-cell undergo apoptosis, i.e. make the cell die.

In other cases, the body will “deactivate” that B-cell. It will survive but will never be able to bind antigen and be activated. This is called anergy.

It survives, but it’ll never find its mate and will never do anything, Dr. Raszka says. “Is that a fate worse than death? I don’t know. That’s a philosophical question for the bone marrow.”

***

We also learn about tissue repair and inflammation from Dr. Ambaye. “Inflammation is a good thing!” he reminds us. We normally associate it with bad things, but it’s a process our body can use to help clear our tissues of infections and repair our tissues back to normal.

Then it’s back to the books. We’ve got a major test next Monday. My group is getting together regularly to review. I think we’ll be in good shape.

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!

Why donate?

(A thing of beauty? from www.abc.net.au)

 We’re done with Bugs and Drugs. Now we’ve started studying the immune system. This is straightforward, but we’re still memorizing all the bugs and drugs factoids. 

On Monday, Dr. Raszka notes that in years past, this is the part of the course where students begin to drift off. To help with that, he tells us, instead of an 8 AM lecture on Tuesday, he’s scheduled that hour as a ”Pause and Reflect” time.

“You may pause and reflect in bed,” he says. Essentially, it’s just an hour of free time to do whatever we want. All of us students applaud.

Dr. Raskza then notes, “Even the TAs are smiling!”

***

To begin our discussion of the immune system, Dr. Raszka asks us to imagine that we’re going to visit aliens from another planet. “What would you want?” he asks. “A spacesuit!” a student immediately replies.

Dr. Raszka then shows a clip from some sci-fi movie, where an astronaut in a protective alien

Point being: Our body needs natural defenses. Even from space invaders.

The immune system has two branches: the adaptive component (i.e. all the cells in your body that specifically target and destroy an invading organism) and the innate component (i.e. all the cells in your body that launch generalized attacks against it.)

To illustrate this, he shows us a clip from The Matrix where Trinity removes a bug from Neo’s body. “What kind of response is that?” he asks us. He then responds, “Trinity. That’s all you have to say.” It’s an example of a specific response. She targeted one organism and removed it.

Dr. Raszka also tells us that UVM is different from many med schools in that we focus more on the innate branch, since that’s what we deal with most of the time clinically.

***

Here’s another interesting factoid we learn: Female beauty in the 1800s was associated with consumption (i.e. tuberculosis)!

Think about the symptoms: bright eyes, skinny (i.e. nearly wasting away), etc. To each his or her own, I suppose. I personally like beautiful people to not be decomposing. Just a personal bias.

***

In MSLG this week, we had nursing students from UVM come in and visit our small group. They’re fourth years, so they’re getting ready to graduate and find jobs.

We ask them about their training, what they do, mistakes they’ve seen doctors and medical students make, etc. We learn that they’ve spent a lot of time learning how to communicate with patients about what’s happening to them. 

We also learn that, not surprisingly, a lot of doctors make the mistake of not consulting with the nurse beforehand about the patient. In many instances, they seem to be in separate spheres, and sometimes even have hostility towards each other. I hope I don’t do that. I volunteered at an ER for two years, and spent a lot of time with nurses. They know a lot.

I’m reminded of a story Dr. Rosen sent to us for this week. A first-year pediatric resident was working in the Neonatal ICU. Before seeing a baby, she pulled the nurse aside and asked her what the nurse had noticed and what she as the doctor could do to keep the baby alive that night, since the nurse had been with the baby for nine hours.

An attending then pulled the resident aside and asked if she always spoke with the nurses about the patients. She told him yes. He nodded approvingly, telling her most residents don’t figure that out until their third year, if ever.  

Her response? “Well, that’s how we learned it in Vermont.” Indeed.

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!

Why donate?

(from en.wikipedia.org)

Today is a more relaxed day. It’s Friday. We get the afternoon off. AND Dr. Raszka is having a dinner at “The Raszka Estate” for all the medical students. He’s promised three different chilis. My stomach is already growling in anticipation.

We start with a lecture from Dr. Raszka on antibiotic resistance, a subject near and dear to his heart. “Don’t tell my boss,” he says, “but there are only about ten things I do. Total.” Most of them are determining why certain antibiotics aren’t working in child patients, which often has to do with resistance.  

Somehow we get onto the topic of Botox. This, we’ve learned over and over again since med school began, is a bacterial that effectively shuts down nerves in areas it’s injected. This naturally disgusts most of us, even Dr. Raszka. 

He tells us that in certain areas, women have “Botox parties” where they all get Botox injections. “They shoot up together,” he tells us, and describes Botox as ”cocaine of the wealthy middle aged set.”

***

We then move onto the Case of the Week. The lecture is exactly what you’d expect. A doctor comes in with a case from the hospital and discusses it with us. We get the patient profile (minus the name, of course), physical exam findings and lab results. Then we discuss the diagnosis.  

This week the doctor is Dr. Mary Ramundo, a peppy woman who discusses a condition known as Systemic Inflammatory Response Syndrome (SIRS), particularly common in patients who’ve had their spleen removed. Incidentally, septic shock is the same thing as SIRS, except there’s also an infection involved.

***

From here, it’s smooth sailing. We do our Review of the Week with Dr. Raszka, who does a quick overview of important points from the week’s lectures.

Then we have a Cookies and Milk session with Dr. Raszka, where he asks us for input about how he can improve the course. I respect him a lot for that. Like a lot of the teachers here, he genuinely cares about how the course is working for students and he will change certain things if need be. Last year, for instance, there was apparently a weekly exercise of sorts that he cut out midway through the course because the students told him it wasn’t working.

Then the TAs have a review session, where we discuss five common cases of infection, such as infection by streptococcus pyogenes (i.e. strep throat), Staphylococcus aureus (MRSA or MSSA) and Pseudomonas (a common bacterial infection in cystic fibrosis patients).    

***

And then off to the Raszka estate. He lives in what I consider a bigger-than-normal house in a more rural and isolated area. Thank goodness, since at least 60 of us show up for this party.

Also, Dr. Raszka has a sheep farm! They do it primarily for meat. It’s not that lucrative for wool, he tells us.

My friend and I hear one of their sheep baahing as we pull up. He even has two baby sheep in his basement in a little playpen. We med students take turns going down in groups to visit them. They’re so CUTE! They’re very domesticated and friendly like dogs, but they’re sheep. So heartwarming.

As for food, the Raszkas’ do not disappoint. The chili, the salad, the garlic bread, the desserts…magnifique. I know a few students who said they weren’t going because they had to study. They missed out. Fun times. Fun times.

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!

Why donate?

(from www.marvistavet.com)

First exam’s done. We now start the Bugs and Drugs part of the course.

Is it a lot of memorization? You betcha. Traditionally this is the part of the course where students don’t do as well, since there’s a lot of bacteria, antibiotics and mechanisms to know.  

Two lecturers take us through these first two days. One is Dr. Douglas Johnson , who gave us the bio review lecture in Orientation. Now he’s taking us through the world of bacteria, helping us distinguish between all the different species and how they can infect us.

Naturally, we end up looking at some pretty grotesque images. ”Always good to talk about bloody diarrhea first thing in the morning,” he tells us.

The other is Dr. Chris Hutton, who walks us through major anti-bacterial drugs. Penicillin G, doxymycin, meropenem, etc. etc. etc. By the end of today, we should know the mechanisms of these drugs, how they’re used and what the toxic side effects are. Pretty routine, but fascinating for me. There are a few drugs we learn about where, according to him, “the most toxic aspect is the price tag.” (Thousands of dollars!)

 Here are some other useful tidbits:

• A “nosocomial infection” is another way of saying “hospital-acquired infection”. Remember that term the next time you’re in the hospital.
• “You are all infected!” Dr. Johnson tells us. It’s true. Almost all of us have tons of E. Coli growing in our gut, which help us absorb nutrients like Vitamin K.
• “Infection is not the same as disease.” Infection is merely the growth of microbial agents, like E. Coli, within us. Disease is when those agents start to injure the host.
• We learn that transmission of pathogens can occur via direct contact. “Handshaking, kissing, sexual intercourse, biting–preferably not all on the first date.”
• There are normally Staph bacteria in your mouth, nose and skin. Sometimes they can spread when surgery gives them access to blood, so they move to other places in the body. We see one patient with a MASSIVE Staph infection that’s known as a biofilm infection because all the bacteria have clumped around one area. “She had a biofilm infection in her ankle because of oral surgery.”

***

Other highlights:

We do a Microbiology lab where we get to put on lab coats and make slides to see E. Coli and Staph bacteria under a microscope. We also get to grow bacteria from our throats by having our throats swabbed with Q-tips and spreading what’s swabbed on agar plates.

We don’t have MSLG this week, but our team gets together to discuss our HEAL project. We’ve been gathering information for a family planning resource fair we’ll be putting on in February for the Bhutanese community here in Burlingtonn.

So far we’ve gathered lots of resources, but we’re still trying to figure out what the fair should look like. We send someone to talk with a Bhutanese representative to learn what might be appropriate for the culture. Fun times.

***

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!  

Why donate?

I’ve been informed that The Legible Script, a national literary magazine published by medical students at the University of South Florida College of Medicine, is now accepting submissions.

I’m planning on submitting some of the best entries from The Meager Med Student, since I’ve written so much on the blog and am still promoting it.

But which ones? I have some ideas, but what do you think? Post YOUR favorite Meager Med Student entry below in the comments. Thanks!

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!

Why donate?

It’s doctoring time! In HSF, we learned how to do basic exams, but now in A&D, we’ll be starting to diagnose patients.

In the introductory lecture, Dr. Razka tells us that in a study, a group of first-year medical students and a group of “soccer Moms” tor teenage children were both given the same med school test, full of clinical scenarios. Suprisingly, the mothers did much better than the med students!

“Why is that?” he asks. A student promptly replies, “Because mommies know everything!”

The reasons why include that the mothers have more years of life experience, so they’ve observed illnesses in themselves, their families and partners.

“You will surpass mothers,” Dr. Razka tells us. But he urges us to remember: “Listen to mothers.”

***

We med students were paired up and given a time slot in which we’d meet a standardized patient (SP). We’d then play-act running through a clinical visit with the patient, in which we’d attempt to diagnose what disease the SP was acting out.

In diagnosing, we use an algorithm Dr. Razka’s proposed, essentially the same philosophy espoused by Jerome Groopman in his book How Doctors Think. Both urge to use a very logical method to diagnose instead of mere “pattern recognition”. Otherwise, you might fixate on an incorrect diagnosis and ignore all the contradictory data.

To illustrate that, Dr. Razka quickly shows us the photo you see at the top of this post. Like most everyone, at first glance you might think it says, “Paris in the spring”. Look again. Your brain might overlook what’s glaringly obvious when you really examine it.  

Here’s the algorithm we’re taught:

1. Learn the context. Get the patient’s name, age, gender, living situation, etc.

2. What is the patient’s chief complaint? (e.g. “I have a cough”, or “I’ve been feeling tired recently.”)

3. Generate a hypothesis. Make a list of the things the patient could have. If they’re tired, for instance, things that jump to mind include cancer, infection, anemia, etc.

4. Note the patient’s general appearance. Do they look anxious? Well-dressed? Is there alcohol on their breath?  

5. Get the History of Patient Illness (HPI). We learned this in HSF. Describe your fatigue. How severe is it? Have you tried to treat it? What makes it better? Worse? etc. 

6. Get Historical Information. Have you had this kind of fatigue before? Has anyone in your family had this? What medicines are you currently taking?

7. Check for risk factors. Do you use tobacco? Alcohol? Tell me about your diet. What do you do for exercise?

8. Refine your hypothesis. If you’ve learned that the patient has stopped eating all meat, for instance, you might suspect anemia due to iron deficiency.  

9. Review of systems (ROS). Think about the different systems in the body that you might want to check or examine when you do a physical examination. You might check the patient’s respiratory system and lymphatic system, for instance, to check for infection.

10. Perform the physical examination.

11. Make a decision. If there seems to be no signs of infection or cancer, I’d suspect anemia due to iron deficiency.

12. Confirm your assessment. Order necessary tests to double-check. For anemia, I’d do a CBC and a peripheral blood smear.

13.Generate a differential diagnosis. Ideally you have a list of backup conditions that could be responsible for the patient’s symptoms. After all, what if you’re wrong?

And of course, the question underpinning this whole process is this: What can’t you afford to miss?

As for my partner and I, we end up working well and finishing well within the time limit. And we not only decide on what’s most likely wrong, but we generate alternative explanations. Very awesome.

***

We have a small group on Thursday to discuss some clinical cases about thrombosis and bleeding. We get the day off after Clinical Skills. I go to the Office of Medical Education (OME) to select a white coat size for my White Coat Ceremony next month, and to look at the Box.

The Box is a sealed cardboard box that’s been in the OME since the beginning of the course. The box can be taken out of the OME for an hour at a time. We can’t open it, of course, but we are allowed to shake, roll, etc. the box to determine what’s in it.

“Don’t bother,” someone tells me. “Someone already got a CT scan of the box. Isn’t that smart?”

I dunno. I admit I considered getting an X-ray, but I decided against it. For me, at least, it would not have been sporting.

***

On Friday, we do a Case of the Week lecture first thing in the morning, which is exactly what it sounds like. Then Dr. Dostmann returns to give lectures on metal poisoning. Again, he’s slightly alarmistic, but he does have some basis. Just a few days ago, there were reports of cadmium being found in cheap imported trinkets being sold in the US, since (at least based off of what I’ve heard) safety standards don’t apply to them since they’re not considered toys.

Then Dr. Razka does a Week review and Block review. He brings out the Box. The point, he explains, was to test our observation and descriptive skills, since that’s a major part of what we do as Doctors. He then opens the Box and reveals…

But that’s a secret. You’ll just have to come to med school at UVM to find out what it is.

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!

Why donate?

(Courtesy of en.wikipedia.org)

 This week is abnormal in that instead of getting our afternoons off, we’re booked until 3 or 4 from Tuesday through Friday, in part because we have a major exam next Tuesday. Imagine learning about different types of cell necrosis (decay), and then immediately jumping into labs on what those necroses look like under the microscope and in anatomy specimens. Very fascinating, but after a bunch of “rushes”, it’s easy to get numbed to how wonderful what you’re learning really is. 

Thank goodness for Washington Winn. Wash, as he lets me call him, is a pathologist at UVM, and he has this habit of sitting back and being informative and practical, while taking time to tell you little stories and jokes. 

He led my lab this week. Fun time. In teaching us how to use Latin to determine what some of the words meant, for instance, he told us how he had a friend who likes to peruse the Oxford English Dictionary for words. One day, he noted that since “disgruntled” has the prefix “dis”, there must be a word “gruntle”. In fact, there is! He discovered it meant ”to be in good humor”, i.e. to be happy. 

Wash then told us he’d get back on track in a minute, since he was almost done with his story. He then said his friend noted that the word had its origin from the word for “pigs snout”. His friend then hypothesized that the picture of complete contentment was a pig running around and dipping its snout in the mud.  

It’s things like having a lab with Wash that help make things a little out of the ordinary. 

*** 

No longer do I have to miss the days of looking at body parts in the anatomy lab. While we’re no longer going there to look at cadavers, we’re now going to the Gross Specimen lab to look at preserved body parts. So now if you want to see a cross-section of a heart with a thrombus in it, you can. 

The room is about the size of a bedroom. One side has glass, allowing you to look outside into the Med Ed hallway, so the lighting is good. And it’s well-ventilated, so you can walk in and not smell of formaldehyde. It’s really cool.   

*** 

We learn about thrombosis, which we’re told is (I am not making this up), “the process by which a thrombus is formed.” One student is overheard muttering, “That’s a terrible definition.” 

We also learn about coagulation disorders, cell necrosis, venous thrombosus, adaptive cell changes, eboli and infarcts. 

It’s a lot. Thankfully, I now have a study group, and we usually review the small group and lab sessions together. It helps you remember things when you have to reteach and rediscuss them with your peers. 

*** 

On Wednesday, Dr. Howe was in the middle of his pharmacology lecture. You know how these things are. 

Suddenly… 

“Can’t read my! Can’t read my! Can’t read my poker face!”  

One of our classmates unfortunately left his computer’s sound on, and for some reason it was now playing Lady Gaga’s “Poker Face” as loudly as possible. 

Everyone, included Dr. Howe, pause and look in his direction. The student chuckles, obviously embarrassed. He tries to turn the volume down, but to no avail. After about thirty seconds, he grabs his laptop (still playing the song) and runs out of the lecture hall. It takes everyone about a minute to recover. 

Later the student walks back in, and even Dr. Howe pauses for a moment as the student retreats to his seat. We chuckle. 

*** 

In MSLG, we talk about doctors and money, which leads into a discusison about conflict of interests and health care costs in the US. I don’t have time to write anything too meaningful tonight, but we did read a fascinating article by Atul Gawande on the subject. 

I also go to a Palliative Care lunch panel, where they provide pizza and bring in several doctors to talk with us about what they’ve learned about breaking bad news to patients. Heading the panel is Dr. Bob Macauley. Always a pleasure to see him. 

Among what they tell us is to consciously be when delivering bad news. In other words, don’t remain emotionally detached. Let your patients sense that you’re there with them. They also tell us that you may be surprised by how people react. One doctor told us how he broke news of a fatal condition to a woman, and she grabbed his hand and thanked him. “I’ve had this back pain for so long,” she said, “and I couldn’t get anyone to believe me. They thought I was crazy. Now I know I’m not. I know why I  have it.” 

*** 

It’s official. I am now co-leading the Christian Medical and Dental Association, along with my friend Leslie. 

This turn of events is somewhat ironic. Faithful readers may remember I did not find the CMDA the friendliest of groups when I first joined. And right now, I am working through some personality flaws. So you’d think I wouldn’t be the best person to be part of the solution. 

But this is something I believe I’m called to do. Our group is fairly young. We’re still discovering how to connect Christian faculty to our group. (Yes, they exist.) And since I’m here for several years, perhaps God will use me to over the next few years to strengthen the group and make it useful for the Christians here.

We had an organizational meeting this week to talk about what we’d like to do this semester. The first-years decided to move from our fairly basic Bible study to practical, weekly conversations about how our faith relates to medicine and medical issues. It’ll be like MSLG conversations, but from a Christian perspective.  I’d secretly been hoping they’d do this, so I’m excited that they suggested it.

What excites me even more? One of the Christian doctors showed up to help guide our organizational meeting. He/she wisely sat in the background, and helped refine our ideas towards what might be most helpful for us. It’s good to know that Leslie and I are not in this alone.

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!

(Courtesy of en.wikipedia.org)

6:00 AM: Wake up. Recall that today is the one day this week I have the afternoon off, since this week abnormally has a lot of labs in the afternoon.

6:30: Breakfast, Bible time, world news and email.

7:00: Preparing to leave. Hope new set of earbuds arrive today. Ordered them shortly after Christmas, and still hasn’t arrived yet. Perhaps I shouldn’t have ordered from Hong Kong.

7:35: Bus comes a little late. One of my regular bus drivers picks me up today. He’s not very talkative to most people, but always greets me (“Hello, sir”) when I come on board. I greet him as well. He always says goodbye to me when I get off the bus, and I say goodbye to him too.  

7:38: Head to library to drop off books and DVDs.

7:53: Arrive at lecture hall.

8:00: First lecturer, Dr. Mark Fung, an MD-PhD, talks to us about patients with bleeding disorders and lab tests you can run to differentiate conditions.

8:15: Realize power strip I’ve plugged my laptop to is dead. Thankfully my battery can last until the end of this lecture.

8:52: Seats in the row across from me are empty. Do I move one row up? Or do I stay where I am, plug my power cord into the power strip in the row in front, and just extend the cable to plug it into my computer? Decide on the latter. There are students on both ends of the row. Who’d move in now and sit there?

8:55: Classmate arrives and decides to sit near where I’ve plugged. Asks why I’ve plugged it there. Thank goodness he’s good-natured.

8:57: Check email. Get letter from Dr. Rosen about our MSLG class. We know we have to write mid-year personal reflection and evaluation essay of our growth in medical school so far. I thought, as with my other writing assignments, it’d be due Saturday. Now learn it’s due Wednesday at midnight. So much for free time today.

9:00 – 11:50: Dr. Fung, Dr. Hardin and Dr. Alan Howe continue with lectures on coagulation disorders, pathologic features of edema, congestion and hemmorhage, and pharmacology of drugs, respectively.

11:55: Look for a study room. All the rooms are taken, save for a few that are reserved for groups that haven’t shown up yet.

11:58: Settle on a room that’s free until 1:30. Eat lunch and do some work.

12:12: Send email to CMDA members about planning meeting tomorrow.

1:00: Exit room and see if any other rooms have opened up. No. Walk around med school multiple times in the hope of snatching a room just as someone exits.

1:10: Give up and head to library. All the tables are full…but wait! There’s one area available. I take it. Continue polishing Evidence Based Medicine assignment that I wrote last night. (Goal: Take a clinical case, find a paper on PubMed and use it to help you determine what to do. Write up a summary of the paper and your clinical recommendation.)

2:00: Submit EBM assignment. Continue writing/outlining.

3:00: Need to listen to This American Life episode on medical expenses for MSLG tomorrow, but don’t have earbuds and so can’t listen in library. Contemplate whether to go home or not to see if my earbuds have arrived.

3:18: Realize I’m out of food in my bag. Guess I’m going home.

3:30: Board bus back home.

3:31: Realize I am sitting near loud college kids. Am reasonably certain they’re high. In a few minutes, their conversation topics include zippers, boxers, pharmacies, restaurants, taking the Lord’ s name in vain and this little gem: “Mark, you just killed my baby!”

3:37: Exit bus. Contemplate that if they kept talking long enough, those kids could discover the solution to world peace.

3:43: Get home. Check mail. Earbuds still haven’t arrived. Rats.

3:45: Make popcorn on the stove and a cup of tea. Eat a banana. Read David Sedaris’s “Me Talk Pretty One Day.” Laugh.

4:15: Back to the books, MSLG paper writing and preparing to lead CMDA meeting tomorrow.   

6:00: Dinner with housemates. Discuss BBC mini-series of “North and South” by Elizabeth Gaskell.

7:00: Back to work. Work on outlining and writing my MSLG paper. Getting the rough draft is always the hardest part.

10:27: Receive email from my MSLG mentor about the assignment that eases the pressure and makes me smile. Thank goodness. I love my mentor.

Verdict: A good day.

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!  

 

Post Still In Progress

Here’s the deal. I need to update the blog, but because I was sick last week, I couldn’t do a daily blog. Now I’m slightly behind. So I’ll post this for now, get back to daily blogging, and fill in the gaps later.

Attacks and Defenses (A&D) begins.

***

For the Science Nerds:

***

Josh Pothen (UVM’s Meager Med Student)

Donate $1 to The Meager Med Student!