1/4

Well hello!

M1 is officially over.  It's an odd feeling, knowing that I'm not going to have to sit through another lecture, open up the quizzes/exam window, or sit in the LRC for prolonged periods of time for two months.  To be more accurate, it's a marvelous feeling.  The year has dragged on.

Tomorrow I am leaving for Kenya - the next big adventure.  But before I go to Kenya I am visiting my friend Kathrin in Germany first!  I could not be more excited!  After 5 days in Germany I'm flying down to Meru, Kenya, to work on a community health survey looking at Long-term disability due to trauma from roadside accidents.  What I am most excited about, though, is that I'm going to be living in a manner completely different than I have ever lived before.  It will be good for me.

But it's late and I've got to play the piano at church tomorrow - I'll write a couple of times when I'm down in Kenya!

On an unrelated note, I'm 1/4 done with medical school! WAHOO!

John

Bugs and Drugs!

Well hello!

I'm smack dab in the middle of the Infectious Diseases.  Up to this point, it's been the most intense sequence.  We've got required small groups every morning (gasp!) about the lecture material from the morning, which starts at 8.  What this translates to is that I'm once again going to class instead of watching the videos from the lecture.  It's rather nice, seeing people and not staring at a screen all day.

Reflecting back on the year, it's interesting to think about how I've changed my studying habits.  Up until this sequence I've "diagrammed" out the lectures, making elaborate webs of connections.  With this sequence, the process became too inefficient.  It took me around an hour to draw out the map on a piece of paper, which simply doesn't translate if there are four hours of lecture in the morning.  To make a long story short, I've gotten on the flashcard train, and couldn't be happier.

I've been using a website called flashcardexchange.net which has been very handy.  If you'd like to try your hand at learning some of the bugs and drugs, here are my flashcards: http://www.flashcardexchange.com/user/view/840692?view=mine&q.

Another way that my study habits have changed is I've forced to become creative in my memorizing.  We've got many different kinds of drugs to learn and every single side effect of every single kind of drug is important - I'm going to be prescribing these drugs someday and don't want to harm someone.  The volume of the material is too large to just use normal materials, so I've turned to the technique entitled "the memory palace": http://en.wikipedia.org/wiki/Method_of_loci.   What I've done is used the upstairs of my house in Zeeland as a location for memorizing the drugs and their side effects.  For example, the boy's bathroom is used to memorize the antiviral drugs and the guest bedroom is used to memorize the Tb drugs.  Within each room there is a person representing a particular class of drugs within the broader subdivision who is exhibiting all of the side effects of the drugs.  In the Anti-Tb room there is my classmate, Isabel, who has is in a wheelchair, has a t-shirt that says P450 with a slash on it, and is clutching her upper right quadrant of her abdomen.  She represents the ISoniazids, which can cause dose-dependent peripheral neuritis (often manifested in weakness of the legs and arms), inhibition of the P450 enzymes, and hepatotoxicity.  I've done this for every single drug of this sequence; it's a full house.

But it's an exam week, so I've got to get to studying.  It's the last week of infectious diseases; I'm ready for the break from the intense material.

On another note, I leave for Kenya in 27 days! WAHOO!

Cheers,

John

We are fearfully and wonderfully made

Well hello!

If my cell phone is correct (and it usually is) it is already March 25. School started on August 1 and ends on June 1. I have been in class for 237 days and have 68 more to go. This means that I am 77.7% done with M1 year! I've said it before, but feel the need to say it again: time flies.

I've moved onto uncharted intellectual territory: the central nervous system. In my life I've never taken a course on how the nervous system works, so everything I've been learning has been new and exciting. To summarize, the CNS is nothing else than a giant conduit for information in the body, and the amount of information that is sensed, transported, integrated, and stored is nothing less than astounding. Little molecules (ions) flowing into channels (voltage gated sodium channels) travel on highly specific paths (tracts) to a certain area of the brain (nucleus) where the information is then registered, and if necessary, an action is performed.

The bulk of the work for CNS has been learning about tracts: where they originate, what they carry, the path that they travel through the body, and where they terminate in the brain. By my count we've learned more than 15 of these All of these connections are what make seeing this computer screen possible, reading and interpreting what's written, breathing, and everything else that we do.

Another more challenging part of the sequence has been neuroanatomy. Anatomically there is more going on above the neck than there is below, and all of this material is condensed into a 3 week period. Here's a picture of some of the nerves of the face:

Someone else puts it better: we are fearfully and wonderfully made.

Along with the advent of spring better weather has arrived. It's been nice to see everything come to life; on my walk home there are flowering trees in bloom. Studying, however, has become more difficult because it's tempting to go and take a walk rather than memorize the tracts of the neural system. I solve this problem by sitting in a chair that does not face a window: out of sight and most of the time, out of mind.

On an aside, I'm going to see the Hunger Games movie this afternoon with people from my community group at my church. I'm excited!

Cheers,

John

Concentrated misery vs. Prolonged discomfort

Well hello!

Much has happened since I’ve last written. Two big weeks happened, one after the other.

First and foremost, I had my last ever spring break. Back in December I received a mass email sent to the entire M1 class seeing if there was general interest in going on a cruise. To make a long story short, there was. There was a ridiculously good deal on a 4 night cruise to the Bahamas from Port Canaveral, and seeing as it was my last spring break and I have never been on a cruise before, I sprung on the deal.

I ended up driving down to Florida with three other classmates, David Giles, Heather Schofield, and Ravi Chopura. We camped on the way down, which was probably my favorite part of the trip.

Playing Euchre in the tent.

In Tennessee hiked a section of the Appalachian trail going through Great Smokey Mountain National park to a point called Charles’ Bunion. It was an outcrop that had a great view over the rest of the park, which was exceedingly beautiful, even in winter.

Charles Bunion, Great Smokey Mountain NP

The next day we camped on the beach near Jacksonville and I saw one of the most stunning sunrises I’ve ever seen over the Atlantic. (On a side note, I’ve decided that I’m a bigger fan of sunrises than sunsets. While they are early in the morning, sunrises cause the earth to come alive and sing with color, rather than having the color die and fade away into darkness.)

Sunrise over the Atlantic. Little Talbot Island SP, FL

On Monday we finally got down to Port Canaveral and boarded the Monarch of the Seas. Cruises are an interesting experience, one that I’m not sure that I’d like to repeat. Yes, it was nice having gourmet food all of the time and not having to think about where one will go next, but at

the same time, the entire experience feels contrived and artificial. Everything about the entire experience feels (and is, in fact,) manufactured. Additionally, the entire trip felt like one big money trap. Pay to get your photos; pay to have an excursion on shore; pay to have soda for the week. In life things cost money and I’m more than willing to pay for them; I just don’t like the feeling of having products pushed down my throat nearly all day. To me, getting in a car with a tent, going someplace that is relatively remote, hiking, and embracing the rest found in silence and solitude is much more relaxing than sitting on a boat in the sun.

All of this being said, I still had a fun time on the boat, entirely due to the fact that there were 50 other medical students on board. (This is not a type-o. There really were fifty.) Getting to know people who I haven’t talked to before was a good experience.

Going snorkeling!

I’ll share a brief adventure from the trip: my excursion into Nassau. To give the story a bit of context, the boat leaves at 11:30 PM, whether or not everyone is on board. At around 7 some friends and I made the decision that we were going to find a place in Nassau called the “fish fry” – a strip of restaurants offering locally caught and prepared fish. So, we found the fish fry, which was around a 20 minute walk away from the boat. The food was absolutely delicious: I had conk fritters, conk salad, and deep fried conk. After a marvelous dinner that lasted two hours, it was around 9:30, time for us to start heading back to the boat. En route we met some other medical student friends who were in search of a jazz club, and I made the decision to join them in their search. It ended up being 10:30 by the time we found the jazz restaurant, which was another 10 minute walk away from the boat. (At this point, I was starting to get a bit nervous…)

The jazz was absolutely astounding. It was an open mic night, and the entire band was incredible. I’ve never heard such marvelous live jazz in my life. In the second song a friend of mine from medical school, Sam, played jazz guitar with the band – it was a special experience. At this time it was around 11, and was far past the time that we should have left to get back to the boat. Fortunately for us, there was a woman from the Bahamas who gave us a ride back to the boat. As we were running up the pier, workers were making preparations for the boat to leave - talk about a close call!

Another special experience on the boat was I was able to give a piano concerto to my classmates, late at night in an empty auditorium. It was marvelous to share music with people again – I truly miss playing the piano for others.

On the way home we drove straight through. We left from Port Canaveral at 9 AM and got back into Ann Arbor at 3 AM. If given a choice, I will always take a concentrated period of misery rather than a prolonged period of discomfort.

The other “big” week was tech week for a play called the Smoker. The entire idea of the play is to gently poke fun at the faculty and medical education in general. This year I was Dr. Kevin Tremper, head of Anesthesiology. The plot was based on the story of Robin Hood, so the title of the play was “Thrombin Hood and his Merry Meds”.

Rehearsal for the play was every night this past week from 5:30-11:30. At the beginning of the week I was diligent during rehearsal – instead of watching the show I kept up with the material. However, at the end of the week I decided to watch the play throughout rehearsal, so I have my work cut out for me during the next few days. (Again, I would rather have a concentrated period of misery rather than prolonged discomfort.)

All in all, the show was a big hit. Everyone involved, from the musicians, to the writers, to the directors, to the actors, were all incredible. The amount of talent outside of academics here at Michigan is astounding. Yet despite how much fun it was, I am very glad to be done. It will be nice to have my nights during the week unencumbered by rehearsals.

On an aside, the alphabet soup of Immunology has started. CD28, TAP, Tregs, Vabs, Ras, CDR, ITAMs, ALPS, CCL18 and so many more little acronyms will be the exclusive content of the next few days. Yet despite the amount of acronyms and studying that is ahead, I look forward to working hard. I am doing what I want to do.

Cheers,

John

The Calm Before the Storm

Well hello!

I am currently writing from the middle of a CFM week - one of the weeks where I get to actually feel like a "real" doctor. The two big tasks this week were to learn the abdominal and musculoskeletal (MSK) physical exams. The former is rather simple - you look at the abdomen, listen to it with your stethoscope, percuss it, and finally palpate. As long as the person doesn't have a big liver or spleen, they're generally OK. For the MSK exam all that one does is go through each joint of the body, move it every which way, as well as try a few specialized tests for the rotator cuff, cruciate and collateral ligaments, and the menisci. Although it seems brief, what I've just written is the distilled essence of both exams, simple and straightforward.

With all of my extra time this week I've taken the time to connect with old friends (I chatted with Daniel Ericks, one of my best friends who I've known since preschool and hadn't talked to since November), spend time with new friends (last night people came over - we played N64 and board games), and catch up on sleep (the past two days I've taken "strong" naps - 2.5 hours long!)

Additionally, tomorrow I am leaving for Spring Break. Around 45 medical students are going on a 4 night cruise that leaves out of Port Canaveral, Florida. We're going to be heading to the Bahamas. I've never been to the Caribbean and have never cruised, so I am quite excited. Don't worry - I'm packing plenty of sunscreen. I and a couple of other friends are roadtripping down, camping along the way. We're stopping at Jones Gap, SC as well as Little Balboa Island State Park. Here is our route:

Yet after Spring Break is over, that is when the real work of the first year of medical school begins. I am currently enjoying the calm before the storm. We have the hardest three sequences all in a row: Immunology, Central Nervous System, and Infections Diseases. The last is particularly notorious - a 5 week long crash courses on bugs: viruses, parasites, and bacteria. I'm looking forward to the challenge.

On another note (or more like 88 notes...), I've finally tuned my piano! Instead of paying a tuner, I bought the wrench (for less than it would have cost to have the piano tuned) and did it myself. (Even though I do not live in West Michigan anymore, I still cling tightly to my Dutch roots!) After 7 hours of tinkering (misery?) and one broken string later, the instrument is finally in tune! I've started learning a new piece: Earl Wild's transcription of the Gershwin song Embraceable You. If you click on the following link, you'll hear a bit of what I'm hopefully going to sound like: http://www.youtube.com/watch?v=7D4nocoFeJM&feature=related

Cheers,

John

Hitting a sweet spot

Well hello!

The middle of the winter, which hasn't been like winter, has finally arrived. That dreaded month, February, is finally here. It's odd for the first time being away from the West side of the state for an entire wintertime - the absence of snow is somewhat startling. Compounding my confusion about the weather is the fact that temperatures have regularly topped 50 degrees. Turning to look out the window, it's a sunny, 48 degree day. To tell the truth, I miss the quiet, deep feeling that comes from having nature enveloped in a blanket of snow. Yes, the sunshine is nice, but winter does not feel like winter to me unless I look out the window and all I see is white.

School has been going well. We just finished up with the Gastrointestinal sequence, which was one of my favorites. Yes, memorizing all of the biochemical pathways was a bit tedious, but after they were learned I was able to take a step back and appreciate how fearfully and wonderfully we are made. Everything is connected. Additionally, the anatomy of the gut was my favorite material that I have learned thus far in medical school. Over 30 feet of plumbing is inside the abdomen - seeing it all is quite an amazing experience.

The new sequence that we're starting is a short one - Endocrine/Reproduction. In short, there are a bunch of little molecules floating around in your blood that are released in response to certain events, and they act all over the place to cause your body to respond properly. Eating and absorbing sugar is an incredibly complex and important process.

Outside of school and the weather, I am being blessed. Recently I joined a small group from my church, Grace Ann Arbor, and although I have only been to one meeting, I know that I will grow from being in the fellowship of other believers. Our apartment is hosting a Super Bowl party this upcoming Sunday, which should be a marvelous time. I'm still getting to play the piano every day - Rachmaninoff Preludes are my most recent project. God is good!

On an aside, I'm going to be back in Holland on Wednesday! I'm excited to see my family!!!

Cheers,

John

Hello 2012!

Well hello!

In case you haven't received the memo, it's 2012! How exciting!

Since early December, much has happened. Christmas break, three weeks of freedom (boredom?), departed as swiftly as it came. I'm trying to recall what I did the entire time, and to tell the truth, I did not do much. Yet in the slowed-down rhythm of life that comes with a long break, I had a marvelous chance to spend time with my grandparents, catch up with my brothers, and read for pleasure. All of these things I do not get to do with any frequency here in Ann Arbor. So although the break seemed tedious after around a week, it was healthy for me to have an enforced season of rest in my life. By my count I only have one more opportunity for this for the rest of my life. After Christmas Break of my M2 year, the rubber finally hits the road. I am excited.

It is not like I sat around and twiddled my thumbs for the entire break, so I'll give a brief summary of what happened:

• Playing Scrabble with my Grandma Betty
• Competing at board games with my cousin Bruce
• Staying up far too late reading (the Hunger Games is a bad book to begin at 10 pm...)
• Meeting up with old friends

Here at medical school I am a week deep into the gastrointestinal/liver sequence. The material is fascinating, especially the anatomy. There is over 20 feet of plumbing inside a human stomach, and how it is all wrapped up inside is incredible. Of all of the material to date, this has been the most fun and exciting. However, there have been two big happenings of the past week: I now have a piano and a house for next year!!!

and...

The piano I purchased with money from my grandmother for Christmas. In the house I will be living with Hope/Calvin alums who are now medical students. The house is RIGHT where we were hoping for a great price. It's the kind of place where we envision staying for at least two years. Thank goodness that we don't have to go through the headache of finding an apartment/rental house in Ann Arbor in the near future.

On an aside, pianos are extremely heavy. I would not recommend moving one up to the third floor of an apartment building that does not happen to have an elevator.

Cheers,

John