Can you imagine what I would do if I could do all I can? – Sun Tzu

October 20, 2012 § 2 Comments

I can imagine that one of the most difficult challenges in life is the discovery that what you want to do is not in line with what you are actually capable of doing. Growing up we are bombarded with the idea that everything is possible if you just work hard enough, if you just believe. The brutal truth is that this is not always how things work out. Yes, you can work as hard as you can and put every ounce of your being into something – but does that guarantee that you will get what you want? There is always going to be someone that has more money, more connections, a better education, or any number of better qualities – physical, mental or otherwise. Does this still mean that anything is possible?

Throughout my life I have believed wholeheartedly that you can do anything if you just put your mind to it, that the only restrictions are the ones we place unto ourselves. Lately, however, I’ve been taking a second look at my loyalty to this belief. Are we really capable of anything? Sure you have your success stories, many of which are made into inspiring movies and books (like the Pursuit of Happiness). One of my favorite quotes from that movie is when Will Smith says to his son:

Don’t ever let someone tell you that you can’t do something. Not even me. You got a dream, you gotta protect it. When people can’t do something themselves, they’re gonna tell you that you can’t do it. You want something, go get it. Period.

At first glance, the quote is all about ignoring the people presented as obstacles on your path to greatness. But there is a second part that is easily overlooked and seldom entertained: there are people who can’t do it themselves. It leads me to wonder why they can’t. Do they lack self discipline or confidence? Do they lack drive and motivation? Or is it that they do not have the qualities, whatever they may be, that they need to get there?

I remember meeting a 17-year-old girl who said she was going to be the first female president of the United States. A grand plan that requires an inspiring type of motivation. But how realistic was it? Had she been given the right tools to achieve such a dream, or was she just a victim of a bloated social illusion of the tangibility of greatness? My questions were answered when she said that she didn’t believe that dinosaurs existed because someone would have taken pictures of them if they did. Was it wrong of me to think that she couldn’t become the first female president? Did that make me one of those people that “can’t do it”? Who was I to make any judgements about her abilities and the manner in which they were expressed?

I wonder: how does one even figure out what he/she wants to do? Does one simply pursue what one enjoys, what he/she is good at, or what his/her parents, teachers or general society want him/her to do? Is there really a perfect fit for the specific, individual traits that we are dealt in life, or do we just pick something and then mold ourselves into the ideal person for it?

I write of this now, not to say that I believe people should hold themselves back and be “realistic”, but rather to reflect on my own fears. How can I be so sure that this is what I am meant to do and that I am not just kidding myself? There were times while attending college in Santa Monica, specially while taking calculus or physics, where I doubted whether or not I was cut out to be a doctor. Those were subjects that I had to take as part of a pre-med degree and I was struggling greatly with them. Did that mean that I wasn’t meant to be a doctor? The doubt grew strong enough that I even took a year off to study art and design. I thought to myself “here is something I am good at. My art is unique and I can learn better techniques to improve it and then eventually market myself. This is something I know I can do.” But there was always a part of me that wasn’t settled. I found myself wandering into the science building, missing the labs and lecture halls, and despising the students there. I ran into a girl I had taken calculus with (the first time) sitting outside of the back of the building, smoking a cigarette. She was a nurse and taking classes to help her prepare for the MCATS. After catching up, I expressed my dilemma. I told of how torn I felt: I was doing really well in my English composition class, being pushed by my art and design teachers to pursue a career as an artist, and had found a true fit in my behavioral psychology class (so much so that I got an A without ever even studying – I enjoyed it that much). On top of all that, I still wanted to go to medical school. She then told me something I will never forgot:

“You have to stop looking for your path in each of those fields individually and start finding one that includes all of them. None of those paths can give you the satisfaction that you feel in the others. The truth is that that one, perfect path is the one you were on. When you are a doctor you need to be able to write well, you are going to be publishing papers and need to be able to effectively communicate your knowledge to others. As a doctor you will need to be creative, as in art, and especially as a surgeon, you will need to understand the biological design of the body. As a surgeon, you will also need to understand the psychology of the patient, their worries, their demons, their fears – you will need to able to sympathize with all of it. Becoming a doctor is the one thing that will fulfill you because it is the only thing that satisfies all the different aspects of your being.”

Needless to say, I was back in the science building the following semester.

I’ve spent a good chunk of my life trying to get where I am now, and now that I am here, I am going to do anything I can to prove myself worthy of this opportunity. There are so many negative opinions about anything and everything that I witness on a daily basis. This is not easy and that hard truth is thrown in our face constantly. Rather than get hung up on the alleged unfair treatment of the students, the difficulty adjusting to Hungarian culture, the language barrier, and the general “this isn’t how we do it where I come from” mentality, I am foregoing my illusions of entitlement, power, and ego. Many may interpret this as weakness or say that I am succumbing to a greater authority because I lack the belief that I can do anything to change it. The truth is that I have yet to experience any injustice. No one has made anything easy for me before, so I can’t expect them to start now. In fact, I welcome challenge. I thrive in it. I want to be broken down because I know that I will survive it and emerge a better person, and doctor, because of it. Yes it was unfair for the girl who failed the anatomy midterm because of one wrong answer, but at the same time, we were expected to know everything. When I went into my own exam, I planned on interpreting my grade, not as a representation of my intelligence or a GPA booster, but as an evaluation of my progress thus far. We want to be doctors. We want to make life-altering decisions on a daily basis – and for that we need to be tough. So why not start building a thick skin now?

There will always be points where I doubt why I am here and whether or not this what I am meant to do. When I consider the sheer magnitude of information that we are expected to master in just these first few months, it almost makes me nauseous. It feels impossible. But then, there are so many that have managed it before me. We all have different tools that we are given in life and I know that the level of difficulty depends greatly on these tools. I know with all my heart that this is what I want and I am going to do whatever it takes to make it happen. It may be easier somewhere else, but I am here now and I am going to make the best of it. I will befriend the doubt of whether this is something I can do and continue until I find out that I can’t.

Do not pray for an easy life, pray for the strength to endure a difficult one – Bruce Lee

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For those interested in my art, here are a few of my pieces:

To achieve great things, two things are needed: a plan and not quite enough time

October 17, 2012 § 1 Comment

It’s unbelievable how much there is to do and how little time there is to do it. I still have not figured out the best way to maximize the few hours that there are in a single day. There’s some secret…I just need to find out what it is.

This morning I asked one of our anatomy TAs how long it took her to feel like she had the hang of things. Her response: “I still don’t”. If I’m not mistaken, she is in her 3rd or 4th year – which means there is no hope! Our professor is still out of town so the head of anatomy visited us a second time. She pulled out the arm we had begun dissecting on Monday, looked at it and said, “what have you done here? Who told you to do this?” Without our teacher there to guide us through our first dissection, we didn’t really know what to do – and it showed. We had cut back the skin and cut away the fat and fascia, exposing the muscle. What we didn’t know was that there was a series of superficial nerves and veins that should have been preserved during the dissection. She was able to find two of the main veins still in the skin and exposed them so that we could see more clearly. Afterwards, we split into different groups: 4 or 5 working on the arm, 5 working on the leg, and then Jannie, Avneesh and I worked on a shoulder covered in muscle. Our task was to identify the muscles and then remove them to expose the joint underneath. One interesting thing we found out today is that our semi-final exam will utilize the very same specimens we are dissecting during our anatomy labs. The bags are labeled with our group number to ensure that it is the same specimen that we are examined on. With this knowledge I now know that all the theory and memorizing should be covered outside of lab and that the time I use in lab should simply be practice for the exam and familiarizing myself with the parts I have already memorized.

While dissecting, there is a lot of eye-watering and sniffling resulting from the formaldehyde. Sometimes it’s easier to tolerate than others. As the head of anatomy was helping at the other dissecting table, we who were standing at the other voiced our thoughts on the formaldehyde. There are times when I can get as close to the specimen as possible without any problems and others where I get a whiff that makes my eyes water so much that it is hard to see and that makes my throat tingle. So, my comment was, “Sometimes I feel like I’ve gotten used to it, but then I get a strong reaction and realize that I’m not”. Without looking up from the leg she was dissecting, the head of anatomy overheard this and took the opportunity to correct me. She said that I was incorrect because the body cannot “get used to” a chemical and then continued to explain the types of things that the body can “get used to”. It wasn’t the best feeling to be corrected in such a way, but at least I know not to say it again 🙂

My chemistry midterm was much easier to handle than I expected. There was one page of open questions (Le Chatelier’s principle, different acid base definitions, hydrogen bonding, ionic bonds, etc), one page with 13 multiple choice questions, and then four calculations. The calculations were much more difficult than I anticipated. I was able to answer two of them with confidence, but the other two (which were coincidentally worth the most points) were a struggle. I filled in as much as I could, wrote down formulas and set up the problems, but nothing past that. At one point I calculated that if I were to miss only two points on the parts I had answered and receive no partial credit on the two difficult calculations, then I would be looking at a 3. I’m not happy with that, but it’s an improvement from me initially thinking that I was going to fail.

The hardest part about this whole process is having no idea what is expected of you. The teachers vary greatly from group to group and there is no clear connection between the lectures and the labs. There is a great deal of information that is on the exams that we are expected to know from before. There is no one book that we are following, but rather a long list of topics that are presented to us and that we are expected to learn about in depth on our own time. I study all. the. time. and yet I still feel like I am way behind. All that says to me is that I am not studying in the most efficient way and that I need to set stricter time limits on specific tasks.

I was happy to find out that I got a 4.5 on my Hungarian midterm, though I would have gotten a 5 if I had remembered some accent marks and switched around two answers. Since the majority of my studying was done in the hour before the exam, I’ll just have to accept it with gratitude. Otherwise we have our Latin midterm next Wednesday and biophysics and biostatistics on Friday. Our homework in anatomy is a light load: learn all the joints and movements of the upper and lower limb, the muscles involved in these movements, their origin and insertion and any limiting structures, and the ligaments, nerves and vessels. This weekend is a long one, due to a Hungarian holiday, which means study, study, study. Even four full days off doesn’t feel like enough time!

 

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Blog post title is a quote by Leonard Bernstein.

Today, I cut into a human arm.

October 15, 2012 § 4 Comments

Now that we have completed our osteology midterms, we are ready to work our way up the “pyramid” of anatomy. On our syllabus it stated that today’s lesson would consist of a dissection of the upper limb. Since today was our first day after the midterm, we were quite unsure of what to expect. We didn’t know whether we were going to be discussing the muscles and joints in theory, or just jumping right in. It was the latter.

Last night I spent more time than I should have searching for the scalpel I purchased at the beginning of the year. After I turned up empty, I resigned to setting my alarm an hour earlier so that I could stop at the NET building before anatomy lab and purchase a new one. I wasn’t sure if I would need it, but I wanted to be ready just in case.

Our lab began with an introduction to the joints by the head of anatomy for the English department of medicine. Our professor is at a conference in the states, so she was there for the first part of class. Rather than explain the joints to us with a wooden pieces, she opened a tub full of real specimens. The smell of formaldehyde in the room was already strong enough, but this tub just took it to a whole new level. We stood up straight in our lab coats and gloves as she demonstrated the different movements using her own limbs and then using some of the specimens. After she left, our teaching assistant gave a little deeper explanation of the shoulder girdle (shoulder joint) before we began our dissections.

As the group was too large to all be crowded around the dissection table, we split into two groups: one to study the joints and the other to begin dissecting the arm. I couldn’t help but push my way into the dissecting group. As our teaching assistant removed the leg and arm from the plastic bag, I found myself in a sort of state of shock. I have never seen any part of a dead human before today and my first time did not disappoint. It is such an out of body experience, one that I can only relate to seeing an accident happening and not being able to do anything about it.

After the arm and leg were on the dissecting tray, our TA told us to “go for it”. We all stood there, trying to decipher what it was that he wanted us to do. In order to give us a little direction, he cut three sides of a rectangular section in both the arm and forearm. The smell of the formaldehyde was so strong that it stung our eyes and tickled our throats. It was almost like smelling menthol and cutting onion at the same time. Rather than get caught up in the utter strangeness of the situation and in the physical effects of the formaldehyde, I told myself to get used to it and just get in there. Another girl in our group, Martha from Norway, had already pulled back most of the skin and began cutting away at the fat. I asked if I could try my hand at it and began carefully cutting away the fat and exposing the fascia, a thin white layer between the fat and muscle that looks A LOT like cotton. It was such an amazing experience to see first-hand what the inside of the arm looks like. To explore its contents and put together all the details we’ve read about in our books. I feel lucky to be in the group that I am in because we are all so team-oriented. Everyone that wanted to dissect got a chance to do so and we were all involved even when not dissecting.

Before we knew it, lab was over. We sprayed the partially dissected arm with a disinfectant spray and then tied it by cutting small holes in the skin pieces and weaving a thin twine through the holes to keep the skin down. Skjalg was waiting for me outside with a smile on his face. This is the closest we’ve felt to being medical students – and it feels amazing!

Now it’s off to study for my chemistry midterm tomorrow morning. Wish me luck!

 

One year ago…

October 12, 2012 § 2 Comments

I don’t know how it is possible, but things are getting even crazier here. All the classes are taking off and I can’t imagine how I am going to keep up with them all. I’ll just have to do my best.

Today in physics we did a lab about special kinds of microscopes. While going through the theory part of the lab, I realized that I recognized the subject matter from when I took physics in Norway. Now, my brain is in no way physics friendly, so taking it in another language than English seemed like such a hopeless idea at the time. But with some hard work and a lot of studying, it actually went really well. As with all of our classes, the information in today’s physics lab hit us like a tornado, leaving us confused and directionless. In order to help me understand the notes I took today, I decided to pull out my old physics notes and was met with a fun surprise: exactly one year ago, I was studying the exact same topic! It’s amazing to think about how much has happened during that time. Sitting there in the classroom that day, I had no idea that in one year’s time I would be in the middle of my first midterm season of my first year of medical school. Since then I have flown around the world, visited Hong Kong and California, taken my first ever verbal physics exam in a foreign language, applied and been accepted to medical school, driven through Europe, moved to Budapest and of course – started medical school. Simply, amazing.

What a difference a year makes (or not at all ;))

From 2011…

 

….to 2012.

 

Midterm 2: Anatomy – Osteology Part

October 10, 2012 § 2 Comments

Anatomy is without a doubt the heaviest of the subjects this semester. Many will say that it is pure memorization, which it is, but only to a certain extent. The most underestimated part of our anatomy studies so far is, in my opinion, the ability to understand the parts, their functions, and how things relate to each other. For example, the eye ball is contained within a cavity known as the orbit. You need to be able to list the 10 structures that make up the surfaces of this cavity as well at it’s 11 connections (through canals, fissures, etc). It isn’t enough to be able to identify a structure upon being asked, you have to know where it is, any other names for it, and it’s relation to other structures.

The worst part about preparing for this exam was that there is no one book that covers all of the features that you need to know. Between us, Skjalg and I have two different atlas’ (Yokochi and Netter’s), the Thieme pocketbook, and Moore’s Clinically Oriented anatomy textbook – and even the sum of these did not contain every detail necessary! We were provided several guides by Semmelweis that proved to be very helpful and slides from the lectures. While these covered some areas not covered by the textbooks, the information provided amounted to only 95% or so of the total possible. I wish I kept a log of each new part I learned, simply so I could put a number to them all now. The best list I was able to find contained 502 structures. That’s right, we needed to know over 500 structures for this exam. Not only did we need to know them, but we needed to know details about them and how they interact with other structures, to draw cavities of the face and explain the borders, connections and surface, and to, of course, orient the bone in the body.

The biggest tool for me in preparing was actually other students. We are split into 15 different groups with 15 different professors and 15 different sets of TA’s, which amounts to a lot of varying information. Each professor has different parts that they like to test students on and the TA’s have endless stories about their own first-year experiences. You never know which professor you are going to get or which topics you will be tested on – so you must be prepared for everything!

I’m not going to be able to reproduce an entire transcript, but I will try to list the structures I was tested on and a little about the format of the examination. We all entered the room as we do at the beginning of every lab, put on our white lab coats, and took our seats along the wall and back tables. The examiners were a 5th year student who is teaching his own anatomy class and our co-professor of histology. We are not supposed to have our own professor for our exam, but since our group was too large for one person, she was there to help out. (We don’t really interact with her, as histology labs are spent staring into the microscope.) They explained the set-up of the exam and then began with the first two students. Since we went in alphabetical order, I was the last one to go. By then it had already been an hour and twenty minutes and our group was a rainbow of emotions. Many had received a grade between a 4 and 5 (5 being the highest), some managed a 2 or 3, some few failed, and only one had gotten a 5.  I overheard the name of many structures that are only included in the more in-depth atlas’ and that are often overlooked by students, for example: retromolar triangle, suprameatal triangle, sublingual fossa, submandibular fossa, sphenopterygoid notch (or foramen if ossified). To calm my nerves during the other examinations, I silently repeated lines from my favorite inspirational video, which Skjalg and I watched twice this morning before the exam.

When it was finally my turn, the female examiner had left, leaving me as the focal point of the whole room. I was handed first the coxal (pelvic) bone, then the talus (part of the ankle), the scapula, the clavicle, and finally the skull. These are the structures that I was asked to identify and explain (those that I remember at least). I was not tested on all the parts of the bones, just those selected by the examiner and there were a few that I include in my explanations. The entire exam lasted about 10 minutes – so it was very, very fast paced.

Coxal

  • I was first asked to orient it in the body and explain how I could identify it as the right coxal bone and the angle at which it sits when standing.
    • Iliopubic eminence
    • Gluteal surface
    • Ala of ilium
    • Ishial tuberosity
    • Greater and lesser sciatic notch
    • Ischial spine
    • Acetabulum
    • Lunate surface
    • Acetabular fossa
    • Obturator foramen
    • Posterior obturator tubercle
    • Anterior superior iliac spine
    • Supra-acetabular groove
    • Pubic crest
    • Symphysial surface
    • Pubic tubercle

Talus

  • I was first asked to orient it in the body and explain how I could identify it as the right talus bone.
    • Posterior and lateral processes
    • Lateral and medial malleolar facets
    • Trochlea – for articulation with the malleolar mortise
    • Anterior, intermediate and posterior articular surfaces for the calcaneous bone
    • Talar sulcus
    • Tarsal sinus – how is is formed by the talar sulcus and calcaneal sulcus
    • Head for articulation with the navicular bone

Scapula

  • I was first asked to orient it in the body and explain how I could identify it as the left scapula.
    • Supra-scapular foramen – I explained that it was a foramen because it was ossified and that it would be considered a notch if not ossified.
    • Infraglenoid tubercle
    • Costal surface
    • Neck of scapula

Clavicle

  • I was first asked to orient it in the body and explain how I could identify it as the right clavicle
    • Sternal end with articular facet for articulation with sternum
    • Acromial end with articular fact for articulation with acromion of scapula
    • Trapezoid line
    • Conoid tubercle
    • Impression for the costoclavicular ligament

Skull

  • I wasn’t asked to orient it…for obvious reasons.
  • I was asked to do the following:
    • Name the processes of the maxilla bone
    • Name the parts of the lateral wall of the orbit
    • Name the parts of the temporal bone
    • Name the bones that make of the superior surface of the nasal cavity
    • Name the bones that make of the bony septum of the nasal cavity
    • Name the foramina of the zygomatic bone
    • Name the connections of the tympanic cavity
    • Draw the path of the facial canal and identify its following features
      • (I included a drawing of the internal acoustic meatus with its facial, cochlear and inferior and superior vestibular area quadrants)
      • perpendicular, parallel and descending paths
      • geniculum
      • canal for the greater petrosal nerve
      • stapedius canaliculus and its connections
      • canaliculus for the chorda tympani and its connections
  • I also had to identify the following features:
    • Clivus
    • Condylar canal and its connections
    • Mastoid canal and its connections
    • Petrosal fossa
    • Tympanic canaliculus and its connections
    • Foramen cecum
    • Pterygoid canal (aka Vidian canal) and its connections
    • Zygomatic canal, including:
      • Zygomaticofacial foramen
      • Zygomaticoorbital foramen
      • Zygomaticotemporal foramen
    • Canine fossa
    • External acoustic meatus
    • Tympanic part
    • Occipital groove
    • Jugular foramen – with a smaller, anteriorly placed part for pars nervosa and a larger, posteriorly placed part for pars veinosa
    • Interjugular process of the temporal bone
    • Mastoid canaliculus and its connections
    • Suprameatal triangle
    • Zygomatic crest
    • Carotid sulcus
    • Dorsum sellae
    • Posterior clinoid process
    • Groove for the greater petrosal nerve
    • Hiatus for the greater petrosal nerve
    • Hiatus for the lesser petrosal nerve and its connections
    • Stylomastoid foramen
    • Petrotympanic fissure
    • Tegmental crest
    • Petrosquamous fissure
    • Posterior and anterior nasal spines
    • Foramen lacerum

End exam

Skjalg and I both got perfect scores on our exams 🙂

Open Season: Midterm Edition

October 9, 2012 § 1 Comment

It’s been a crazy, crazy 5 days since I last checked in. Friday was yet another tough lab day, though slightly more tolerable than that before it. The best part of the that day, nay, that week, was actually when our professor for medical chemistry agreed to move our midterm to the week following our anatomy midterm. This is our new midterm schedule:

There really is no end to the midterm “season”. Once the last midterm of the first round ends, the first of the second begins. In most of our classes, we will have a total of 3 midterms before the final exam. If do well on our midterms, our cumulative score may exempt us from the semi-final.

Both Saturday and Sunday consisted of getting up at 7:00, doing necessary chores, and then sitting to study either at home, the National library, the 24-hour library for Semmelweis students or at the café located near our gym. On Sunday Skjalg and I headed to the gym around 11:00 and got in a good workout before studying at the café. It’s hard to work in time for yourself when there is so much to be done. I’m sure we will get better about it as the weeks go by. Right now is all about finding what works best and adjusting when it doesn’t.

Yesterday and today were hell days. My friend Rina and I spent almost every free minute in the 24-hour library, taking advantage of the plastic skeleton they have there. At times like these when all the different faculties have their midterms it is almost impossible to get any time with the bones. The anatomy museum has a capacity of 50 and the extra sessions they have organized in the anatomy dissection rooms only provide access to 2 or 3 skulls. When you have possibly 1000 first-year medical students between the Hungarian, English, and German programs fighting for access to 50 seats or 3 skulls, the chances are understandably minimal.

This afternoon we had our Hungarian midterm. I have been operating under the belief that active participation and focus during class would be sufficient enough cover the necessary content for the exam. I do my best to speak the little Hungarian that I can when I am out in the city and will sometimes listen to a Hungarian language CD while cooking and just repeat what is being said. I spent about an hour before the exam reviewing the topics covered in the past 5 weeks and glancing at the sample exams in the back. On a quick bathroom trip before the exam, I passed the following post on a student cork board. I tore off “luck” and shared it with the rest of my group on the way in to the exam.

The Hungarian exam was easier than I could have imagined. It was plain and simply the topics that we have covered. As long as I continue to work hard in class and exercise my basic Hungarian in daily life, I think that I will be covered in terms of preparation for that class. But we’ll see 😉

A day in the life…

October 4, 2012 § 3 Comments

 

Here is what my day looked like today. Not really a need to question why I am so deliriously tired. Tomorrow is hell day (4 back to back labs) and is followed by a weekend of cramming for midterms, which start next week. We have Hungarian on Tuesday, anatomy on Wednesday, and medical chemistry on Friday. After that we have two more weeks of midterms (Latin, medical biophysics, and biostatistics). Yippee!

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