"A good time"

One thing that one learns shortly after matriculating into medical school is that the train has truly left the station.

Yes, there are short pit-stops along the way, but momentum soon builds and getting off of the tracks is difficult.  After first year the details are still fresh - starting immediately onto second year makes sense.  After second year the details of basic science have been burned into the brain by studying for step one - proceeding with clinicals immediately causes the relevant information (~10%) to stick.  After third year taking step 2 immediately happens right away as details from specialties one will not be entering slip through the cracks.  On a smaller scale non-stop nature applies, also.  During the first and second year the amount of material is a veritable mountain.  During third year there is always more to read, both relating directly to the patients as well as preparation for the shelf. And the principle repeats itself over and over:  life does not slow down.  If anything, along its path, the train accelerates.

The time passes, ever more quickly.  An hourglass is turned over, always, and sand is continuously dropping from the top to bottom.  A glance away, an hour passes.  Another glance, a week; a month; a year. I graduate in 117 days to go to a residency somewhere.

When is it a "good time" to start something new outside of medicine, given all of the other things occurring?  Simply put, there is not.

As time becomes more and more scarce, the more precious it becomes.  People who have to be at work for 95 hours a week understand the value of time away from work and choose to spend it accordingly.

A clear awareness of the passage of time combined with knowledge of its increasing scarcity makes the memories of what is done with the time all the more precious as well as lend keen insight into what one truly values.

On the trail.

Residency interviews have been happening since early November.  Overall the experience has been positive; I can honestly say that I could see myself being a resident everywhere I've interviewed.  Two more places to visit and then I am all finished wearing a suit, attending a dinner, and explaining what I'm feeling called to do with life.  Along the way I've met many incredible people, visited many incredible places, and managed to get my car hit by a deer driving through the middle of Wisconsin.

Early on in the process there was a newness and excitement; now there is a certain tiredness to the entirety of everything.  Meeting people who will be making decisions about your future is accompanied by a certain exhaustion. I have been doing a good job refusing to become anxious about where I will be for the next five years - there has been a peace about the search.

In the meantime I have been able to return to Zeeland and have spent more time with family than I have during all of medical school previously.   Seeing grandparents for meals; going to Faith Reformed Church; enjoying coffee at LJ's; playing the piano for my teachers; getting doughnuts with the neighbors.

The time away from medicine has made me appreciate it for what it is (the best career in the world) and gives me excitement for July.

Waiting.

There are different seasons of medical school.  Spring, the newness of first year and the steady hum of lectures and quizzes continuing on until second year.  Summer, third year, a flurry of activity found within clerkships and sub internships during early fourth year.

I am currently in the midst of autumn, the in-between season.  Applications have been submitted and preparations are complete to get back on yet another interview trail.  More suits, more dinners, more important conversations.  More being "on-point".  All of this to lead to a carefully considered, ordered list, followed by a Nobel-prize winning algorithm which will tell me (hopefully) where I will wind up for the next five years of my life.

The grooves of perpetual activity run deep.  After so much time of continually having things to do - the next quiz, the next rotation, the next shelf - all that I have currently is time.  Time to sit, time to read, time to have dinner with friends.  Time to wait.

It is into this place that the Word comes and speaks.  Do not be anxious about anything; consider the lilies - not even Solomon in all of his splendor was clothed as these; but those who trust in the LORD will renew their strength.  The season of waiting is an opportunity to be deepened in reliance in the plans that have been made, plans that are made to give a hope and a future.

A hymn from my past comes to mind, when I think about the uncertainty that permeates this autumn season:

Because He lives, I can face tomorrow,
Because He lives, all fear is gone;
Because I know He holds the future,
And life is worth the living,
Just because He lives!

Beethoven and the rain

Instead of sitting inside to to do some errands online I sat on the porch in the rain.   While outside I listened to Beethoven Op. 101.

The sonata is one of my favorites as of late, along with Op. 110. After thinking about it, there are slow passages in both in the middle-upper register, which I find the most beautiful of all the tones on a piano.

Despite my recent foray into Russian music, Beethoven remains an ever present friend, especially in the rain.

All thy fullness

I have been on the surgery rotation at the VA hospital for the past 2.5 weeks.  It has been a good experience - I am learning more and more every day about what it means to function as an intern and am getting an idea about what it means to be a resident, and ultimately, a surgeon.  The more time I spend on surgery the more I enjoy the time - I am beyond excited to have this as my future career.

On the drive to the VA every morning and back to my house I listen to the same song, recorded by Hope College's Chapel Band: All Thy Fullness: http://hopecollegeworship.bandcamp.com/track/all-thy-fullness-single.

All Thy Fullness

You are my fullness, firm and steady;
To lavish mercies, at the ready;
Despite my wand’ring, Despite my weakness
Unrelenting strength and goodness

Holy Holy
God almighty
All thy fullness
Here beside me

You are my courage, truth and wisdom
Guiding hand and purest vision
Hope in fear, joy in victr’y
endless song, hope and yearning

I am breaking, you are building
I am empty, you are filling
In my silence, you are speaking
In my dying, ever living

Holy Holy
God almighty
All Thy fullness
Here beside me

Holy Holy
Alleluia
All Thy fullness
Here among us

It is centering, to listen to this as I go to and from work. 

PAACS Conference, part 1

I managed to slip away from my pediatrics rotation for two days to attend the Pan-African Academy of Christian Surgeons (PAACS) conference in Des Plaines, Illinois.  A number of things had to go "right" for me to even get to the conference in the first place:  a rotation during the conference that would allow me time off, having an outpatient month during the conference, flexibility of the schedule to allow me to spend 2.5 days in Chicago.  Coincidences do not exist; God has sent me here for a reason.

The ride down was with Dr. Bob Cropsey, a general surgeon who worked for his career in Togo, a small country in West Africa.  Our riding down to the conference happened, again, coincidentally:  I attended a breakfast only this past Saturday and it happened, again, coincidentally, to come up that we were both heading to the same conference.  Again, more "coincidences".

Our conversation revolved around his experiences as a long-time mission surgeon.  Hearing about how he was used throughout his career was inspiring.  I get the sense that my time at the conference will be incredibly important for giving me a vision of how I can serve for the kingdom in the future.

M3.85

A theme in my thinking has been how the time passes.  Our memories to not respect the same linearity that time passes.  

Already M3 year is more than 5/6 done.  Six more weeks of pediatrics and I am along to the "promised land" of M4:  subinternships, applications, interviews, away rotations, matching, and graduation.  Less than fourteen months from now I will be finished with medical school.  It all went so fast.

The fourteen months are shaping up to be busy.  Step 2 in early June, studied for while on Anesthesia and leaving for multiple weddings on the West side of the state.  Three surgery rotations in a row:  Hepatobiliary, VA, and Thoracic.  Applications happening concurrently with all of this madness.  Finally, interviewing, during which I will be *hopefully* brushing up on my French and preparing a recital program to fundraise for away rotations at mission hospitals.  Finishing up the year by spending three months away at locations to be determined.  The time passes so quickly because of the fact that it is so filled to overflowing with all of the different exciting problems that come with planning out the future.

Confronting the busyness of medical school and the resultant perception that time is slipping through fingers like grasping onto grains of sand comes the concept of rest, like the sudden a minor cord in the second movement starting Beethoven's 7th. What does it mean to sit, to take time to listen to classical music not while studying, to take a walk not for the purpose of going someplace, to take the time to call a friend not while en route, to go to a coffee shop with nothing on the schedule afterwards.  The fact that there is less free time makes it a precious commodity.

Layers

As time passes, certain events are encoded into memory.  The slightest stimuli unleashes a flood.   A waft of fresh-baked cookies triggers fond remembrances of home; the sound of rain on canvas, camping trips.

It is our collected memories, and our perceptions that stem from them, that are the core of ourselves.

----

Classical music is an obsession of mine.  I have played the piano as long as I can remember and I do not go a day without listening to it.  While studying I prefer Glenn Gould's Bach - the Goldberg Variations are a particular favorite - but while taking a long drive I prefer Rachmaninoff preludes.  I made the mistake of listening to Violin Partitas almost exclusively while studying for Step 1 and I fear I may have ruined listening to them for ten years, at a minimum. There is a reason that people still listen to classical music even though the composers are long dead:  classical music taps into the depths of human experience.  (What was the top song of 2006, again?)  I listen to the same works over and over again.  When I hear the Beethoven symphonies I can tell what's happening next; with his piano sonatas, I hum along. 

As a consequence of listening to the same things over and over again, they have acquired layers of meaning.  I reserve the 4th movement of Beethoven 5 for moments of triumph.  Walking out of an exam I listen to it nearly every single time.  Brahm's Intermezzo in A is saved for decompression - when I want to sit back and relax after a long day of work I close my eyes and let the sound wash over me.

----

Today I discharged a man to palliative care.  It was the first time I've done this.  He had a long and complicated stay in the hospital - over the fifteen days of his stay he was cardioverted, delirious, and sent in for an embolectomy secondary to critical limb ischemia.  Delirium imposed on his history of paranoia and dementia made him what the interns call a "rock" - someone who is staying on our service for a while due to the fact that no other place will take him.  Late in his course his oxygenation started to fail and he developed a wet cough, secondary to his failing heart and a month and a half of not eating.

As I went in his room to say goodbye he had a rare moment of lucidity.  I took his hand and started to say goodbye.  He looked at me, in between coughs with naked fear in his eyes, and said "Am I going to go?"  Not "go" in the sense of leave the VA, go permanently, as in die.  I did not know what to say.  I had no comfort to offer him, save that he was going to a place where they were able to take care of him.  How utterly inadequate I felt.

While I was sitting in the room blaring in my head was the opening to Mozart's Requiem; the ponderous d minor opening was playing as I was holding his hand.  The crescendo to the haunting entry of the baritones sounded as I left the room.

Requiem aeternam dona eis, Domine. Grant him eternal rest, Lord.

A new layer has been added to the work: the sight of an 86 yoM with a pmhx of dementia, paranoia, Parkinson's, and CHF being put on a stretcher to go and die.

I'm back!

As it's a new year, I thought I'd give another crack at it.  Previously my posts have been a bit more themed; I  think that I'm going to switch things up and go for a more free-form approach to blogging in hopes that it will result in more posts.  I'm not going to be writing for anyone in particular this time, just for myself.

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

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.