Put your pride to the side

November 27, 2013 § 4 Comments

Winter has arrived in Budapest. The cold air and snow flurries bring with them the promise of Christmas, cozy winter nights and…exam period. The obstacles we have to tackle to just get to the exam period are enough to make any one of us nauseous at the thought. It’s unbelievable how many exams we’ve had this semester. In one way, it is good because we have gotten used to having exams, on the other, we are constantly stressed and constantly studying. There is no chance for downtime and that means we will begin exam period completely exhausted.

Tonight is exam registration, which is quite possibly the most stressful event of the semester. At 20:00:00 on the dot, 220 2nd year students will furiously click away at the registration boxes for their planned exam dates. For some of the exams, there are only 20 or so spots – and those are gone within seconds! If you’re lucky, you’ll get all of your planned dates before the system crashes, which it always does. Skjalg and I spent an hour or so last night trying to figure out how our exam schedules should be. For the first time, we’ve planned to do our exams on the same dates. Hopefully we get them! Last time, Skjalg’s computer froze and he had to completely rearrange his schedule. Fingers crossed!

Tomorrow brings our dreaded tripple-exam day. Despite a decent study weekend and some hardcore studying on Monday and Tuesday, I’m not feeling good at all about our biochemistry midterm. I sacrificed going to several of the lectures in order to study for other exams, thereby risking not being able to prepare properly for this exam. Though it worked out for those other exams, I now have to face the consequences of my sacrifices – and it’s not an easy pill to swallow! I completely underestimated the amount of information we needed to cover for this exam – way more than what can be reviewed in only a few days time. The worst part is that I really, really like what we are covering in biochemistry this semester. I find everything so interesting and it is so frustrating that I can’t give it the time it deserves. Some light reading for summer break, maybe?

It’s difficult to motivate yourself to study for an exam when you are convinced it is not going to go well. My trick has been to focus on the semi-final and how studying for this exam will help me there. But that trick can only go so far. Last night I hit a wall and since then, I haven’t been able to get anything in my head. The prospect of going to three exams tomorrow, two of which I will most likely fail, is a miserable thought and a serious blow to my pride. With the amount of time and energy I put in to studying, it’s hard to believe that I am even in this situation. But what can I do? There’s no changing the past, so my only option is to use these lessons to make me a smarter student.

Skjalg once told me something that I use to comfort myself on a regular basis. I’m quick to associate my exam scores with my intelligence and therefore tend to assume that any low exam score means I have a low intelligence. It’s natural to be a little self-critical (or, let’s be honest, a lot self-critical) and this is definitely one of my big insecurities. So one day Skjalg said, “You’ve gotten into medical school in part by your intelligence. That is one of the factors in a complicated series of events that enabled you to get to this point. Everything after that point is about preparation. It’s not that you can’t learn any of this, only that you didn’t learn it – for whatever reason that may be. Someone knowing more than you about something doesn’t necessarily mean that they are smarter, it only means that they had the time to learn it.” I felt so good after hearing that because it forced me to focus on something I can change – the way I study – versus something I can’t – my mental ability. You can be an amazing artist, but if you can’t market yourself, it’s going to be hard to make a living off of it. So, I have to work smarter, not harder.

That said, I’m off to study for a short while before exam registration. The adrenaline rush from that should be enough to fuel me for a few hours afterward.


Anatomy Midterm 3: Check!

November 24, 2013 § 6 Comments

This week has been completely draining – and we have to keep going! On Wednesday we had our 3rd Anatomy midterm of the semester. The topic for this semester is neuroanatomy, but this midterm included regional anatomy of the dorsal regions. This meant that we needed to be able to present all of the regions on the back side of the body through all layers – from the skin down to the bone. This required us to review a lot of information we covered in the first semester of first year.

To start the exam, we had to pass a written portion covering the cranial nerves and spinal nerves and plexuses. There were 10 questions total and we had to pass with 6 correct in order to be accepted to the oral portion of the exam. The questions were similar to the following:

  • Which nerve innervates the skin between the 1st and 2nd toes? (Deep peroneal)
  • Which nerve innervates the epiglottic vallecula? (Vagus, CN X)
  • Which nerve pierces the scalenus medius muscle? (Long Thoracic)
  • Which cranial nerve carries “guest fibers” from the spinal cord? (Hypoglossal, CN XII)
  • What are the terminal branches of the tibial nerve? (Medial and Lateral Plantar Nerves)
  • Which nerve innervates the interosseus muscles of the hand? (Ulnar nerve)

I passed with 7 correct. I have a stupid habit of not really reading the question correctly and it has cost me quite a few points on exams this semester. I’m working on it…but the habit still creeps up when I am nervous. There was 1 question I had to guess on (the scalenus medius one) and the other two were stupid mistakes – I read epiglottal tastebuds instead of epiglottic vallecula and “guest fibers from the spinal cord” made me immediately think the vagus nerve, since it gets its internal branches from the accessory nerve (although those fibers originate from the nucleus ambiguus and not the spinal nucleus of the accessory nerve). But I passed the written – and that is all that matters!

The oral part was extremely nerve-wracking. Normally I am called first, since I am last on the roster (they like to start from the bottom apparently). This time, I wasn’t called first…or second…or third…or fourth. The tension builds up to unbearable levels during the wait. We have to do our oral exams in front of our entire class. The cadavers rest on tables in the middle of the room and members of the group sit around the periphery of the room. My group is amazing, everyone supports each other and we are all hard workers, but that still doesn’t stop me from getting a little stage fright, to be completely honest.

Jannie and I were sitting next to each other, waiting for our turns, when sunlight broke through the clouds and streamed in through the windows. We moved so that our faces were in the sun and laughed nervously at the thought of what we looked like. The examiner looked over at us and laughed, asking if we were always so smiley or if it was just nerves. Suddenly we heard loud sobbing from the next room. One of my group mates whispered the name of a notoriously tough examiner and suddenly it felt like a wave of fear washed over the room. When examiners are done examining their assigned group, they will check the other groups to see if they can help to wade through the students. This makes it so that you never know who you are going to get for your exam…

Immediately after the cries of the sobbing girl reached our room, the door opened and the aforementioned examiner stepped in. At that point, my stress level exploded. I was so nervous I felt paralyzed. I kept trying to calm myself with mature thoughts, but with that level of adrenaline coursing through my body, no mental trick was going to make a difference. Jannie was feeling the same way and looked over at me and whispered, “this is horrible!” Soon, another examiner entered and the original examiner motioned towards Jannie and I, smiled and said something that sounded like, “take the sunny girls” in Hungarian.

We ended up having our exam together, which made for a nice yet awkward experience. It was nice to not be completely alone with the examiner, but it also prevented me from getting into a groove. If either one of us didn’t get the question right away, he would ask the other, and he went back and forth in this manner the entire time. I really don’t think this is the best method because it doesn’t give the examiner a chance to assess your knowledge without outside influence. Plus, as Jannie said afterwards, it makes the entire exam about comparing us to each other rather than testing us fully on our knowledge.

It went well in the end, so I guess it wasn’t that bad 😉 I ended up with a 4, which was perfect. It reflected my hard work, but showed that there was still room for improvement. I put in almost 60 hours of studying for this single exam over the past few weeks, but I realized that a lot of that time could have been spent more efficiently. The guides I made detailing the layers of the dorsal regions were a great study tool, but I think I spent a little bit too much time on them. They will, however, be a great asset when preparing for the final exam.

Thursday required us to be up and at ’em again for our weekly physiology quizzes. It was so difficult to study on Wednesday after our anatomy exam – especially since I only got 4 hours of sleep the night before. I was able to go through all of the material before the first quiz, but I don’t think I did very well. We were asked to draw these graphs and I couldn’t recall all the details:heart3 Picture10

Thursday night ended up being a night off, though not really a whole night, since we weren’t done with our physiology lab until 19:00 and then didn’t get home until 20:00 since the subway wasn’t working. Now it’s biochemistry time! On Thursday we will have our physiology quizzes at 14:00 and 16:00 and then at 19:00 we will have our 2nd Biochemistry midterm. I still can’t believe we are going to have 3 exams in one day. This isn’t a game, folks! 🙂

In the wee small hours of the morning

November 20, 2013 § 4 Comments

Our anatomy exam is racing towards us and I feel the panic settling in my stomach. I’ve been studying for the past 11 hours and I think that I might need to call it a night and get a good night’s sleep. I have so many worries about tomorrow and there is so much more that I still want to cover. My brain is having a hard time wading through all the information that I am trying to cram into my head. It’s not that I waited until too late to start studying, but rather that I began to lose confidence in the things I did know and now I feel like I need to hold on to them as tightly as possible. So, in an effort to evade the panic, I am taking a deep breath and reminding myself of a couple key things:

  • This is medical school, which means that I need to know – and I mean really know – what should be covered for the exam. I’ve written before that I should look at each “failure” as an opportunity to improve my knowledge – and it is equally true now! If I fail an exam, it’s because I didn’t have a good enough foundation to move on to the next level. The best thing to do is stay strong through the critique, allow myself a few moments of self-pity and then do whatever I need to do to be better the next time around. Now is the time to make mistakes if we are going to make them at all. That’s what learning is about!
  • I have given everything I can to this and in the best way I knew how at that moment. I can’t expect anymore of myself and I should therefore not beat myself up over what I have or haven’t done up until this point. Whatever happens will only stand as feedback to my method of preparation, not my intelligence.
  • Despite all the stress, lack of sleep, poor nutrition, etc., I actually had FUN studying for this exam. The human body is amazing and I learned so much! Plus, I got to study with Skjalg and Jannie and we enjoyed ourselves while we studied.
  • I realized that going over material we covered last year is going to be a lot easier than I thought. I’ve been dreading the final exam in Anatomy, but in the past few weeks, I’ve come to appreciate how much my mind has changed over the past year and a half. The way I interpret, learn, visualize and process information is on a completely different level than it was. I am able to consume vast amounts of information – both visual and theoretical – and memorize it within a few repetitions. I am able to relate structures to each other and deduce answers from few facts. Anatomy has it’s own language – and we’ve learned it!

Ok, on that positive note – and the quick escape from reality – I’m off to bed. I will be getting up in 5 or 6 hours, just to review…but at least it’s not an all-nighter. Progress, not perfection 😉

Staring into the Abyss

November 18, 2013 § 4 Comments

We’re one day out from our Anatomy midterm and after that, there will be no stopping the inevitable. Wednesday is Anatomy, Thursday boasts our weekly Physiology quizzes and next Thursday, our weekly Physiology quizzes AND our second Biochemistry midterm, covering lipid and protein metabolism. Then we have one week with just our Physiology quizzes and the last week of school will close out big with a Hungarian end-of-semester exam, Physiology lab exam and Biochemistry lab exam (Skjalg and I will also have an exam in our elective course).


There may be one more exam for me on top of all that. If I pass Wednesday’s anatomy exam, I will be exempt from a pin-test covering brain anatomy and dorsal regions of the body. If I don’t pass, I will need to take this pin-test in two weeks time. Normally, the dissection exam is part of the semi-final, but this year, they have made it part of the semester exams. If we pass all the midterms, we don’t have to do it. Over 100 people have failed either the first or second midterm, so it will be interesting to see how this ends up….It’s hard to believe that we have to go through all this to just get to exam period!

Skjalg and I have been studying together for this anatomy exam – possibly the first time we have studied together since first semester. We have quite different study tactics and ways of learning, but so far it is going really well. Hopefully it pays off!

Dorsal region cramming

Dorsal region cramming

To study for the dorsal regions, I made guides with tracing paper so that I could visualize each of the layers. Worked really well for this visual learner!

To study for the dorsal regions, I made guides with tracing paper so that I could visualize each of the layers. Worked really well for this visual learner!

Jannie and I went for a walk on Saturday morning and then had coffee at Starbucks. Nina and Jay were our alias' for the day ;)

Jannie and I went for a walk on Saturday morning and then had coffee at Starbucks. Nina and Jay were our alias’ for the day 😉

Skjalg and my weekend cramming spread

Skjalg and my weekend cramming spread

We didn't have internet this weekend, so we had to make a quick stop into Starbucks on Saturday night to use their internet.

We didn’t have internet this weekend, so we had to make a quick stop into Starbucks on Saturday night to use their internet.

Sunday morning in Budapest! Skjalg and I went for a walk and then grabbed breakfast at Starbucks and ate down by the river. Have to make time to enjoy the small things in life :)

Sunday morning in Budapest! Skjalg and I went for a walk and then grabbed breakfast at Starbucks and ate down by the river. Have to make time to enjoy the small things in life 🙂

That’s what’s going on on our monotonous end! Wish us luck 😉

On the bright side

November 12, 2013 § 2 Comments

Two posts in two days – doesn’t Bianca have anything better to do? More effective things yes, but as I close in on hour 11 of studying for today, I decided to sneak a little break. My arms and back are in serious pain, which is understandable considering the amount of sitting we do…and the slouching that comes with it (good posture only lasts for the first hour max). I try to vary my sitting position often, throw in mini dance breaks or arm-swinging/stretching sessions, but sometimes it gets to a point where I just need to stop for a little while. So, here I am, sitting in Skjalg’s massage chair, arms rested at my side, typing away – which surprisingly enough isn’t aggravating my “student pains” as much as would be expected.

What inspired me to take this break (in addition to my body screaming at me) was an interesting topic we are covering for this week’s Physiology quiz. I find that I spend so much time focusing on – and writing about – the amount of material we have to cover and not mentioning anything about the material itself. What we are learning now is so much more interesting than what we learned last year. A whole new world of information has opened up to us and we now have the tools we need to understand it all. Yes it’s hard, but it’s also quite amazing. Sometimes I take a step back and look at the sentence I just wrote/read or replay a conversation in my head and I am instantly aware of how much knowledge hides behind those words. It’s easy to take for granted how much we have learned and therefore important to take the time to reflect on how far we have come. The easiest way to do that is to talk to someone outside of medical school. The majority of our time is spent with people just like us, which makes it that much easier to lose perspective. A social base of medical students and doctors is far from diverse…

So back to that interesting topic in Physiology. We’ve all seen movies in which a person receives bad news and faints. Having never seen anything like that for myself, I always chopped it up to a dramatic Hollywood stunt. But it turns out that there is truth to it! It is called vasovagal syncopy. Syncope is “fainting” and vasovagal refers to the effect of the vagus nerve (one of the 12 cranial nerves (nerves that exit directly from your brain), which is responsible for the majority of your “rest and digest” functions in your body).

Now, I hope I explain this right – if any reader knows better, please let me know ;). We have a system in our body that is activated during anticipation of stressful situations. This system causes dilation of the blood vessels in your skeletal muscle, so that when you need to act fast, more blood can flow through and supply your muscles. In our lecture, it was mentioned that this operates only under very specific situations and he used professional sprinters as an example. When people experience a vasovagal syncope, there is a malfunction that stimulates the part of the brain (hypothalamus) that controls this system. Now, the blood vessels in our body dilate/constrict based on the need of the tissue. We have about 5.5 liters of blood in our body and if all the vessels were to be dilated at the same time, we would die because tissues wouldn’t get the oxygen and nutrients they need. This gives an idea of what a controlled system it is! This malfunction causes the blood vessels in the skeletal muscle to dilate and since skeletal makes up such a large percentage of our body, the person’s blood pressure drops and as a result his/her brain doesn’t get enough oxygen – which is why they faint.

As for some other fun/exciting things I’ve learned or gotten to do these past of couple weeks:

  • Learned that fat cells (adipose tissue) actually regulate how much energy you use/burn. So you can eat less and your body will actually work to keep more energy!
  • In anatomy we got to use a bone saw to cut open the skull of our cadaver. Our professor told us that it is the same saw that they use when doing brain surgeries. Amazing.
  • In physiology lab this past week we did a procedure with live rats (under heavy anesthesia) where we had to isolate the nerve in charge of controlling heart rate (the vagus nerve) and stimulate it with electric current to analyze the effect on heart rate and respiration. My group mates were nice enough to let me do most of the procedure – which was fascinating! We’re so used to cutting into cadavers that cutting into live tissue was a huge change. I was too gentle in the beginning of the procedure so the technician had to help me get it started. We would have been there for hours otherwise!

Alright, back to studying for me. Hopefully this massage chair has done it’s job!

Calm before the (next) storm

November 11, 2013 § 4 Comments

The dust has only just settled after the exam chaos that closed our October and opened our November – and its only a matter of time before it rises again. I’m so deep in that even writing even the previous sentence was a struggle because “tetanic contraction” or “applying stimulus late in the relative refractory period” seemed like more fitting metaphors. It’s week 10 of the semester and we have already had 21 exams – 17 seminar and lab quizzes in physiology, 2 anatomy midterms, 1 biochemistry midterm and 1 Hungarian midterm. And what do we have to look forward to? 12 more exams. After that, ironically enough, exam period will start. Martha, a friend and fellow group-mate said this morning that she is almost looking forward to exam period because at least then we will only have to focus on one subject at a time.

This week is the “calm before the storm”. Next week we have our 3rd Neuroanatomy midterm which includes the cranial nerves, intercranial topography and spinal nerves and innervation of the dorsal regions of the body. If we pass all the midterms during the semester, we are exempt from a end-of-the-semester pin-test exam. I’ve passed the first two, so I am really feeling the pressure of this one. In addition to the nerves, we need to be able to describe each of the dorsal regions, including all the layers, muscles, blood supply, etc. We covered that in the first semester of first year, but it’s a lot of material to brush up on. Let’s just say that my confidence in my knowledge of the material we covered when we first started medical school isn’t very high…

My plan for this week is to study anatomy today and then for this week’s physiology quizzes on Tuesday, Wednesday and Thursday morning. Normally I spend Monday studying physiology, but I’m sacrificing it this week in hopes that it helps me pass my anatomy midterm. After Thursday’s quizzes, it will be all-in for anatomy! I might set aside some time for next week’s physiology quizzes (since we will have those the day after the anatomy exam) but I’m not sure quite yet. I feel like everything in second year is a gamble. You put your study hours into whatever subject you can and hope that it pays off. When it doesn’t, it’s a big blow, but you just need to brush it off and keep going. No time to wallow, this is about endurance. As our TA told me today, “It’s all uphill from here”. So, I’m sliding my boxing gloves on and locking away my pride. I need to be ready for whatever comes at me, accept the lessons within each experience and visualize myself across the finish line.

Here are some quotes about strength that are currently supplying me with motivation. Beautiful and accurate 🙂

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Guest Post: Skjalg and the Roux-en Y Procedure

November 4, 2013 § 1 Comment

Hi everyone! It’s Skjalg!

Bianca asked me to write a post about an experience I had a couple of weeks ago. I thought “here’s my shot at glory and fame”, so here it goes. I apologize for the length. Apparently I had more to say than I thought.  🙂

Every week we have a class called Introduction to Clinical Medicine, which entails that we go to a different department of the hospital to see how they work and learn about a case or two. Since we had a very similar class last semester, it has begun to feel a little repetitive. Not because they don’t want to teach us interesting things, but sadly at our current level of knowledge, there are very few cases that are simple enough for us to grasp. However, the experience I am going to share with you was a little different.

It is no secret that I would like to become a surgeon after completing my medical degree, so I was excited when I realized that we would be visiting the Department of Surgery. I admit that I didn’t expect that I would get to see much, but nevertheless there was a glimmer of hope.

We split into our usual groups and a nurse led us around. The first half hour of our tour was much of the same.  “Here is how an empty operating room looks like”, “here is the monitor for the ECG readouts” or “here is the machine that does this and that”. We were then asked to change into surgeon gear. This was first time we got to put it all on. We usually get a white or green coat, but this was the whole shebang. We were then led into a room were they were doing what appeared to be an appendectomy. It was a very dark room and the doctor did everything by looking a monitor. We were shown how the anesthesiologist had her equipment set up and after about 5 min we were led out again. It was fun but not overwhelmingly exciting.

Across the hall there was another operation going on and the nurse went in to see if we could pop our heads in there as well. After a minute or so, she had gotten the OK that a couple of us could come in and look for a short while. Two of my classmates quickly jumped at the chance and I was a bit bummed that I hadn’t acted more quickly. After they came out, she said two more could go in for a quick look. This time I didn’t politely wait – I jumped at the chance and got it. So did Chiara and Toni from my class.

The room was brightly lit and there were three doctors working on a patient. To each side and behind the chief surgeon were a couple of surgery interns looking over his shoulder. At first our view was mostly obstructed, but we could see that the abdominal cavity was opened from above the cloth separating the patients head from the operating area. Then one of the interns standing on a box behind the chief surgeon asked if I would like to take her place. It was perfect! I now had a full view of what the surgeon was doing.

The abdominal cavity was fully opened, the stomach had been removed and he was in the progress of removing large parts of the intestines. I was in awe. The surgeon moved so confidently, much faster than I would have expected. He burned his way through the tissues (as to diminish bleeding) and sliced off the part of the intestine that needed to be removed in a couple of minutes.

It was amazing to see how skillfully he sutured the parts together and checked every detail while doing so. He managed his assistants’ delegations with hardly any words and everything seemed like it had been done a thousand times before. By now, Chiara was standing on the box beside me and Toni, the taller one of us, was peeking over his shoulder. We all stood there mesmerized as the surgeon kept working. By now 20 minutes had passed; the others had long since left to switch places with the other group. I knew that if we left it would be a very long time until we had this chance again, so I told my “partners in crime” that we could sneak in with the next group as they came to the end of their tour. And so, we stayed for another twenty minutes. The surgeon was now past the hardest part and as he continued suturing, he explained what had been done and what kind of techniques he had used. We stood there like three groupies hanging on his every word. The remainder of the time flew by and before we knew it, the next group was there. We snuck out of the room and mingled in with the rest, although with conspicuously grins on our faces.

The surgery we saw was called a Roux-en Y. This form of surgery is sometimes used in gastric bypass operations, but in this case, cancer had started in the patient’s stomach and spread to the spleen and parts of the intestines. I was surprised enough to learn that we can live without our stomach and even more surprised to learn that it presents hardly any problem. If anyone wants to know more about the type of surgery, here is a short video with animations of the surgery and a longer video with actual video feed from a similar laparoscopic procedure.



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