It's the most wonderful time of the year...

Well hello!

Somehow December has arrived. Yes, I've swapped out my shorts for pants, my sandals for wool socks and shoes, my t-shirts for Cabela's coat, but all of these choices were made with a desire to stay warm in the cold weather without the concurrent realization that 2011 is almost over. It's just hit me: it's December.

Associated with December are so many wonderful tings: Lights, music, friends, and family. Potlucks, concerts, snow, and gift-giving. In the past week I've eaten with friends five nights, watched the Messiah and the London Philharmonic, and visited with a friend from Hope who was in town for a race. This coming weekend the Christian Medical Association Christmas Party is being hosted at our apartment. (Cookies, a Christmas Movie, White Elephant Gift Exchange, Ugly Sweaters, and the like - it's going to be a wonderful time!) Indeed, Christmas is the most wonderful time of the year. Academically these next two weeks are relatively light; we're learning about the Kidney. The difficulty in medical school is not in the nature of the material, but in the quantity. As such a two week sequence is roughly a quarter as difficult as a four week sequence - there is simply less that needs to be remembered.

The most eventful happening of the past week was the Intermural Broomball Championships. I was on the M1 team, the Not Docs. We rolled through the playoffs, shutting out every team that we played. Yet the competition that we faced was not too stiff - waiting on the other side of the bracket was the formidable M2 Broomball team. We met last night at midnight in the championships. Despite a valiant fight, the M1 team fell in a battle, losing 4-1. We held on 2-1 until the last 5 minutes, at which point our aggressive play led to two easy goals. To fire up the team and fans (there were around 25 M1's as 15 M2's at the game to support their respective classes) I got a haircut for the game. And Dad, don't worry - I "fixed" the haircut this morning.

On an aside, I'm going to be home on the 17th!

Cheers,

John

The (first) home stretch...

Well hello!

MSK is now over and this past week was Thanksgiving break! It was my first time being at home for a significant portion of time since July, and it was absolutely marvelous. Some highlights:

• Dinner at Daniel Erick's new HOUSE! It was wonderful get a little slice of his married life in Hudsonville
• Spending time with David Giles, a med school friend originally from Oregon who came to our house for Thanksgiving break
• Trying to make up for months of missed board game time with Bruce Kraay, my cousin
• Visiting with my grandparents! It was so good to see them!!!
• Thanksgiving at the Holleman's house. It never ceases to amaze me how such a large quantity of
  excellent food can be consumed at one location by 20ish people. Thank you for hosting, Uncle Kevin and Aunt Lynne!
• Walking along Lake Michigan on Friday - it was a blustery cloudless day; the sound of the lake was all-enveloping as I took a stroll along the water's edge.

The most exciting thing that happened during break was the big game: U of M vs. Ohio. (That other school from Colombus doesn't even get the dignity of being called by its proper name.) One of my best friends, Matt, and his wife, Casey, came out for the game on Friday night. On Saturday morning there was a bit of a mishap: I could not for the life of me find one of the tickets. I scoured my entire car and apartment twice, and the ticket did not turn up. Depressed and downtrodden, we set out for the tailgate party under the assumption that I would watch the game back at my apartment while Matt and Casey were in the Big House. We got around a minute away and Matt said, "John, we need t

o look for the ticket one more time".

To make a long story short, the ticket was found inside my sweatshirt pocket. I have not been so excited for the longest time - I sang the Hallelujah Chorus bounding down the stairwell. After a couple of other mishaps we got into the game, which was an absolute blast. In my past I have not gotten into games, but this game was unlike any other in the past. Before Saturday, Michigan had not beaten Ohio for seven years. Entire graduating classes of Wolverienes had not witnessed a U of M victory. When Michigan came out on top on Saturday after the harrowing finish the entire stadium nearly exploded. Students rushed the field, Sweet Caroline blared over the speakers, and the entire city celebrated.

On another note, I'm on the (first) home stretch: 3 weeks until Christmas break! If you'd like to hang out or visit, let me know!

Cheers,

John

MSK hits home

Well hello!

I am now writing from the other side of the Cardiovascular Sequence; my life is no longer confined to the beating of the heart of the inspiration of the lungs but to the extension, flexion, abduction, adduction, rotation, and circumflexion of joints. Innervations, origins and insertions, not electrical waves or pressure gradients, are now the things that consume most of my waking hours. It is a welcome change: I truly enjoy anatomy. We are in the labs three times a week dissecting, finding muscles, picking away at fascia, and tracing vessels or nerves. The sheer amount of memorization is a bit staggering at times, but fortunately for medical students, most of the names are somewhat intuitive. For example, the flexor digitalis profundus is the deep muscle that flexes the digits. The extensor palmaris longus is the longer of the two muscles that extends the thumbs. It would have been helpful to study Latin, but I am getting along just fine.

One of the reasons why MSK has "hit home" was an event that happened two Saturdays ago. I was riding my bike downhill down Division street and a car passed me. (Here is where the details go a bit foggy.) I remember the car turning out in front of me into a driveway, and before I knew it I was flying through the air off my bike, landing on my right forearm, and then slamming onto the ground onto my back. (All that the driver said was "I'm sorry" and "I didn't see you".) The wind was completely knocked out of me, and my forearm had felt better, but other than that I was fine. After a brief trip to the First Aid station, an ice pack, and 600 mg of Motrin later I was in the stands singing Hail to the Victors. Unfortunately the swelling on my arm had gotten rather large during the game:

The arm was so massive that I decided to take my roommate's good advice and go into the ER, after I was finished cheering on U of M to a victory. I got an X-ray taken:

The good news: my arm wasn't broken! The bad news: I was feeling intermittent tingling on my fifth digit, or pinky. The line on my arm above the massive bump is my ulna, which is on the pinky side of the arm. On that side is the ulnar nerve, which provides information about what's going on relating to the skin on that side of the hand. Because there was so much blood (or, a hematoma, if you want to be technical) in that area of the arm compression of the nerve was happening, causing the tingling sensation. Coincidentally (or not) this was exactly what we were covering in lab last week: innervation and muscles of the forearm, anterior compartment.

Also, I'm guessing this wasn't in mind when UMMS said that they encourage "active learning".

On an aside, I'm going to Louisville, KY this Thursday-Saturday for the Global Health Missions Conference. I couldn't be more excited.

Love,

John

P.S. MY ARM IS COMPLETELY FINE! THERE IS NO PERMANENT DAMAGE!

Lifeisablur

Well hello!

It's funny how time gets away from you, especially when you are busy. Class, labs, studying, meetings, small groups, and the like. Last post I made a promise that I wouldn't be delinquent about writing, and here I am, a month after my previous entry, writing again. (I apologize.)

Cells and Tissues is long gone; Clinical Foundations of Medicine flew by; and two-ish weeks ago I took my deep breath before the plunge that is the Cardiovascular/Respiratory sequence. Each sequence has a different quality and reputation, and the current one is reputed to be one of the best. Gone are the long lists of acronyms and cellular pathways, here are models of how the heart and lungs work. It's all variations on a theme: there's a pressure or concentration difference and everything goes downhill.

I've been taking most of my quizzes on Friday so weekends have been blissfully free. Two weeks ago my cousin Bruce came out with a friend Robbie, which was wonderful. This past weekend was jam packed: Fall Ball (a medical school formal) was on Friday night; on Saturday I went to Akron, Ohio with my friend from my class, Nicko, for a concert; yesterday afternoon I went apple picking with around ten other people from my class. Sometimes I think that I tire myself out on the weekends more than I tire myself out during the week!

As far as this week, things are looking great. I've got a dissection and am pumpkin carving with the Galen's Medical Society tomorrow, am hosting a potluck for members of the Christian Medical Association, and my roommate (Nick Holst) and a friend from undergrad (Rob "RIB" Peterson) are coming to visit for the weekend!

On an aside, I've been in Ann Arbor for 2 months and 22 days. Lifeisablur.

GPCR, NF-KB, PLC, PKA, I-KB, cAMP, Bal-1, Cdc-25, Apf-1, Bad, Bax....

Well hello!

First, I need to apologize: I have not written in a while. Writing a blog only takes an hour, and I've definitely had an hour of free time since August 22 that would have better spent writing. This won't happen again, I promise!

Since my last post quite a bit has happened. Briefly, here is a list of what has happened:

• My close friend Daniel Erick's wedding!
• Michigan vs. ND game with my older brother, Steve. It was the best football game I've ever attended. (Or am
  likely to attend.)
• Getting lost while going to a canoe trip, which actually ended up being a marvelous time.
• Michigan vs. EMU. A football game that wasn't too terribly interesting.
• Staying up far too late with my friend Yashar playing video games.
• Having some of the MSTPs (Md/PhD candidates) over for dinner: crockpot chili was a grand success!!!
• Playing soccer with other medical students on lazy Sunday afternoons

Now, finally, to the main subject: Cells and Tissues. Here at Michigan, the curriculum is divided up into sequences. The subject of this one is how do things really, really, work inside the cell. It's a fascinating subject: tiny molecules, proteins, work with little chemicals in the most specific and highly regulated ways, to make your body work. You've got to sort the right proteins to the right place (which is not a small task, believe me), with the correct orientation, at the right amount of time, in response to the correct stimulus, and they need to be broken down so that their effects do not continue for too long.

In summary: what goes on in all of our little cells, all the time, is something that is so incredibly complex and wonderful that I can't even begin to describe or fathom it all.

But, what this means practically for students, is lots of acronyms. Right now an ocean of acronyms is floating around in my head and I need to be able to tell what they're doing in response to what, how these proteins are turned on/off, and a number of other details that at times all tend to get all jumbled together. Here is a picture of what this means for me studying: I make mental maps.

I've got pages and pages of these maps, and most of them make sense. Yet after the sequence I know that I will forget the majority of what I've learned. Oh well. Such is the nature of school.

On an aside, I'm very happy. I love school and I love learning and I love my classmates and I love Ann Arbor and I love life. Things are going well!

Two thoughts

Well hello!

Amid the hustle and bustle of studying, lectures, and required events, the little things to make life run still must happen. Laundry needs to be done; food needs to be bought. I’ve been doing all of my grocery shopping at Meijer, my mainstay from my time at Hope. At Hope everything was so convenient. At every block there wasn’t a stoplight; pedestrians didn’t haphazardly decide to walk out into the middle of the street; hills didn’t make biking to another place an intense workout. (This isn’t to say that I don’t like Ann Arbor – I love it – it just takes more time, effort, and frustration to get anywhere. Everything, regardless of distance, is twenty minutes away.)

During my first few weeks here I was glued to my GPS; I would ride my bike, holding onto the handlebars with one hand and in the other hold up my phone, receiving directions to wherever I was going. I’ve been weaning myself off of the directions: I can proudly say that I navigated to Meijer without any electronic assistance. (Side note: I need to make only two turns to get to Meijer. Yes, I am directionally challenged.)

During my drive, not using my GPS, riding with the windows down, listening to John Mayer, I thought to myself: “This feels normal.” It was the first time in the first three weeks that I felt like I was going about a normal rhythm of life, not embarking on a quest with an unsure ending. It hit me: I am going to be in Ann Arbor for the next four years; I am here for the long haul.

Yesterday I went to play soccer with the other medical students. After the rainstorm hit, the sky cleared up and the afternoon was an absolute peach. 75 degrees and blue skies. It was a great time – two hours of running around and chasing a ball is strangely therapeutic. We played at Mitchell fields, which is located right next to the helipad for the hospital. During the two hour period during which we were playing soccer helicopters landed at least 10-15 times.

Myself and many of my classmates continued to run around, chasing the ball, while this occurred, not stopping to think about the reality of what was happening: someone needed help so desperately that they had to be flown to the University Hospital. The situation was almost ironic; we continued to play soccer while someone was nearly dying. Leisure and death, side by side.

As I was faced with this juxtaposition, I had another big thought: all of the people playing soccer will be saving lives someday. All of the people in our class are going to become a doctor, and we are going to be the people waiting for the helicopter to arrive, rather than the people playing soccer next to the helipad.

On an aside, I’m going to a Demolition Derby on Tuesday – it’s going to be a great time!

And so it begins...maybe

Well hello!

First quiz: donezo!

Yes, after two weeks of class, I had my first quiz. No, it was not terrible, but all the same, it felt good to get it under my belt. Right now we're covering things that I've already learned about for the most part (with the exception of pathology), so I'm not being washed over by waves of new information. Yes, there is a different spin on most of the material that has been presented, but it's no surprise. Transcriptional regulation. Basic statistics. DNA. Translation.

Additionally, we don't have any labs, which will come soon enough.

In summary, medical school has started...maybe. When I'm dissecting cadavers and learning physical assessment skills, the maybe will became a "most definitely". Until that time I'm going to relish Patients and Populations.

On an aside, there was a birthday party this past weekend. Streamers, anyone?

Orientation!

Well hello!

The past two weeks have been a blur. 169 new classmates. A number of new professors. Navigating through a new city. The past two weeks have also been two of the most exciting weeks of my life.

There are a number of things that need to be taken of during orientation. Class introductions. Curriculum. Honor code. Team building. Computer policies. Three days of all of this. At the end of it all I was ready to be done.

Today was the first day of class. Three lectures: medical genetics, introduction to pathology, and principles of uncertainty in medicine. Interesting, but nothing to call home about. What made the day was the first patient presentation.

For patient presentations, the entire class actually dresses the part of a medical student: church clothes and white coats. A woman came in and talked about her experiences having a child, a child who happened to have Down's Syndrome. Hearing, and gaining even an understanding about, her experiences and how doctors have walked alongside her and her son, from the initial knowledge of the son's disease, to the multiple heart surgeries, to the countless other trips to the hospital for other "small" incidents, to their life today, was truly moving. It was wonderful, at the conclusion of a long time sitting through rather dry orientation sessions, to be reminded of the true reason that I'm entering medicine: to be a doctor, along with everything it entails, for patients.

On an aside, here's a picture from my first day of school:

T-minus 7 days!

Well hello!

The deep breath (summer) before the plunge (medical school) is nearly over! Exactly one week from this time I'll be moving into my new apartment in Ann Arbor! All of the furniture is bought; all that remains is to pick up the U-haul trailer and start lugging couches, beds, mattresses, and chairs up three flights of stairs.

The deep breath truly has been a deep breath. I've been intentional about taking this summer easy: taking a roadtrip, going to the beach, spending time with grandparents, and reading books for run. Over the next few years my time for all of these things is going to be significantly limited, if the rumors I've heard about medical school are true.

The time for rest is nearly over and the time for work is beginning. Thank goodness - I can only take so much rest.