Third Semester: Check!!!

January 22, 2014 § 7 Comments

Which means: I’m going home to see my family!

At the moment, I’m waiting for my connecting flight in London. I’m beyond exhausted. I honestly can’t remember a time I was more exhausted than I am now. I’ve had 5, maybe 6, hours of sleep in the past two days and traveling might squeeze me dry. If I wasn’t so drained I would probably be able to feel the pure excitement and relief that should be consuming me at this moment. But nothing feels real! I feel like I’m I some sort of alternate reality or in the between.

I will write more when I have a chance. Typing on the iPad is not so easy and I didn’t bring my computer with me. But for now, we are done!!

Exam Period: At a Glance

January 18, 2014 § Leave a comment

I’m taking a little study break and thought it would be interesting to visualize this exam period by the amount of hours spent studying each day. Of course, everyone has different study techniques. Mine is pretty much: get up, study, go to bed, get up, study, etc. I’m really bad at taking time to do anything else. Skjalg has been really good about getting out – he’s even been going to CrossFit classes 4 times a week. I wish I could relax the same way that he can. I will say that he has rubbed off on me a little over the years…at least I take breaks now.

I use an app called TimeSheet when I study to log my hours. I’ve mentioned in several times before. It’s a really great tool for getting an idea of how much time certain tasks take and how much time is really needed to study for something. So, I used the app info to add the total study hours to a calendar. The numbers represent the amount of hours from when I sat down to study to when I stopped (so they include break time, which usually totals an hour or so a day…sometimes more).

This might give you a better idea of what we go through during exam period (and explain why we are so stressed and exhausted!).

ExamPeriod1 ExamPeriod2Alright, break over, back to reviewing this amazing topic…

Cholesterol transport

When your best isn’t good enough

January 18, 2014 § Leave a comment

As can probably be deduced from the title of this post, our biochemistry exams did not go as hoped. I’ve been taking it a lot harder than I expected. Normally, in the hours before an exam, I get a calm sense of clarity. It usually follows my thinking that I will pass the exam if I have the knowledge required to pass and then accepting that a failing grade is just an opportunity to learn the material better. There are a lot of really, really good things about me needing to retake the exam, but right now, I’m allowing myself a bit of a wallow period.

The main reason for my wallowing is that I had a flight booked for California this morning. On Christmas morning, Skjalg surprised me with the perfect gift: a trip to see my family. He, his family and my mama, all got together for the ticket and the trip was set for the day after my last exam. When I got the present, I immediately started crying. I haven’t been home to see my family in over two years now (the perils of living abroad). My mom came to visit me last winter, but I have not seen the rest of my family since my visit in January of 2012. I haven’t mentioned the trip because it was conditional upon me finishing my exams in time and I didn’t want it to add to the already unbearably stressful exam period.

Xmas Present

Skjalg is such the artist ūüėČ

Waiting for the results yesterday was a terrible experience. Skjalg and I only managed an hour or so of sleep the night before the exam, so we should have been tired enough to sleep until the results were uploaded. We were able to keep ourselves down for an hour long nap, but after that, it was just constant refreshing of the webpage that would showcase the results. Skjalg got his result first, mine was updated about 30 minutes later. It was morning in California at that time and my mom was up and getting ready for work. She messaged me to ask how it went as my result loaded on the screen. When it loaded, I felt such an overwhelming sense of shock and sadness. I’m thankful that we were messaging in the moment because it saved me from having to worry about how I was going to tell her that I wouldn’t be coming home just yet. As usual, my mom was supportive and understanding, but that didn’t stop me from starting a battle with myself.

To make matters worse, the details of the exam were uploaded this morning. I failed by ONE POINT! One single, little point. The exam was divided into 3 sections worth 30 points – (1) Open questions about any of the topics (2) 30 multiple choice questions about carbohydrates and metabolic integration, and (3) 30 multiple choice questions about¬†lipids, amino acids, nucleotides, porphyrins. We needed at least 15 to pass in each of the sections, plus our total points (sum of this exam and our bonus points) needed to be 56. However, there is a ‘1-point rule’ stating:

‘1 point rule’¬†if any of the blocks contains 14 and the others 15 points or more (T) + the laboratory exam is evaluated by either 1 or 2 points (L), the grade for final-examination is 2 (pass) if the sum of scores and points (T+L+M+B) are 59 points or higher.

What did I get? 21/20/13.¬†I have 4 bonus points from presentation/lab work from the semester and 2 from the lab exam.¬†That means that I would have passed with a 14 instead of a 13 in the third section – sliding in at total 61 points. I still can’t believe it – one point!

Exam results

As I resumed studying today, I kept an eye out for exam questions that I might have answered incorrectly. One of my mistakes was writing that the enzyme dihydroorotase catalyzes the reaction of dihydroorotate + NAD+ to orotate + NADH+H+. The enzyme that actually catalyzes that reaction is dihydroorotate dehydrogenase. Dihydroorotase catalyzes the reaction that generates dihydroorotate from carbamoyl-asparate by cleaving off a water equivalent. Silly me for mixing those two up! However, since this was an open question, it wouldn’t have helped me pass if I had gotten it right…

Skjalg and I will be retaking the exam on Tuesday at 11:00. My flight is rebooked for Wednesday morning and I am going to do everything I can to make sure I am on it. I appreciate this opportunity to cover the information more thoroughly – something that will pay off when it comes to preparing for the final exam at the end of this year – but I’m still bummed. I pushed myself so, so hard for this exam, despite being sick. I let myself sleep enough hours to keep me going, but when I was awake, I was cramming. Sometimes, no matter how hard you work, no matter how hard you push yourself, things don’t work out the way you want them to. But that doesn’t mean you should stop.

So, I’ve given myself today to wallow (while studying, of course) and from tomorrow, I’m putting my fighting gloves back on. Churchill always helps me with that ūüôā

2543830789222939818QFf6wMbc churchill D46OG.jpg

Keep Swimming

January 14, 2014 § 3 Comments

T-minus 2 days until I am maybe, possibly *fingers-crossed* done with exams! To be honest, I’m not feeling too great about this one…though I don’t recall ever feeling great about an exam. After running myself into the ground cramming for anatomy, my body was ripe for the picking for any and all bacteria/viruses that thrive in the winter cold. Though I took Thursday off, it wasn’t enough rest to keep the cold at bay. The past few days have been a struggle. I’m sleeping long hours – 9, even 10! – and managing to study while I am awake. I’m nowhere near my A-game, so I’m a little worried about this last exam. Nothing worse than getting sick during exam period!

Biochemistry is considered the “easy” exam of the three, but it is by no means easy. This exam covers bioenergetics and carbohydrate, lipid, amino acid, heme and nucleotide metabolism.

BioenergeticsCarbohydrates1Carbohydrates2 Screen Shot 2014-01-14 at 11.57.33 Screen Shot 2014-01-14 at 11.58.45The only comforting thing about preparing for this exam is that I have finally learned how to take useful and effective notes in biochem! Despite being sick, I have been able to cover everything after the first midterm and have created a guide that I can use when preparing for the final exam. (I was pretty prepared for the first midterm, after that physio and anatomy got in the way, so my biochem vigor dissipated.)

In case you’re curious, this is what biochem looks like – a la Bianca.

Activation of FA Pyrimidine Synthesis Succinyl-CoA HDL

Anatomy III: Check!

January 8, 2014 § 4 Comments

Yesterday was a day I’d been dreading for a long, long time. The few days leading up to the exam were terrible for me. I don’t think I have ever been as stressed as I was then – and I can get pretty stressed! I started not being able to sleep more than 10 minutes at a time and on the night before the exam, I was only able to stay in bed for 2 hours. Laying down and closing my eyes was torture because it gave my brain the chance to play out every worst-case scenario. When the day arrived, I was absolutely miserable. I believed whole-heartedly that it was going to go badly and was dreading having to go to the exam to confirm that fear. With such little sleep and so many stress hormones flowing through me, I was a shivering mess come exam time. When the examiner came to collect us, I noticed that my legs felt like spaghetti.

The four of us settled in our respective seats in his office and I was shown a fan-like arrangement of green cards. Picking out your topics like that is one of the worst things I know. It’s a fair way to do it, but then you feel 100% responsible for your choice. I always catch myself thinking: “my choice right now could make or break me”. No pressure though…

I was so nervous and sleep deprived for this exam that I literally could not think straight. I was boiling inside my suit and could not stop shaking. When he asked me to show him the topics I’d chosen, I was shaking so badly that he couldn’t read them off the card. I apologized and he smiled and said, “It’s okay. It’s nice.”. I wonder if by “nice” he meant endearing? It was such a horrible feeling because I know that, in exams, half of it is how you present yourself and your knowledge – and I wasn’t doing a very good job.

That said, these were my topics:

Anatomy Topic I:  Nuclei, course and fiber composition of the branches of the accessory (XI) and hypoglossal nerves (XII)

For these I made drawings of the nerves leaving the brainstem and then added in which muscles they innervated at the end branches. He ended up asking me some questions from material covered in previous semesters – and let’s just say I wasn’t prepared for that! My mental block was completely solid at this point. It was like I knew nothing other than what I had been able to write down on the page. So when he asked me questions like, “what are the infrahyoid muscles?” and “what are the muscles of the larynx?”, I was caught completely off-guard. Luckily it didn’t count against me. I think it was more of his way of giving me an idea of what it could be like in the final exam at the end of the year.

AccessoryNerve HypoglossalNerve

Anatomy Topic II: Nuclei of the Cranial Nerves

I started out doing a drawing of the dorsal brain stem, but couldn’t think clearly enough and couldn’t remember what I was doing, so I found it easier to just list them out. I say “easier”, but it was so, so hard. I was under so much self-inflicted pressure and was really struggling to organize my thoughts. I think I spent 45 minutes just trying to put it all together. The worst part about this topic is that we covered it in the middle of the semester – so I should have known it well from before. I’d left topics I’d covered well during the semester until the end of my exam prep, not considering that I would probably be too stressed to absorb the information properly. Anyways, I was able to get it all down in the end. Since I had already done the 11th and 12th cranial nerves in my first topic, I was able to leave those two out.

Screen Shot 2014-01-08 at 17.45.26Screen Shot 2014-01-08 at 17.44.36

The examiner wanted to just look at the list, saying that it was such a big topic and would take too much time to explain. By this point, any brain power I had was completely drained, so when the follow-up questions came, my delivery was lacking. Luckily, he could see my answers and knew that I knew it. After my shaking episode in the beginning, I’m sure he knew my mental state.

  • What are the GVM (general visceromotor) nuclei? Where are they located in the brainstem? What is another name for these types of nuclei?
  • What group of nuclei are in the ventromedial part of the brainstem? And the ventrolateral? Which nuclei are included there?
  • Which nuclei provides parasympathetic fibers to the facial nerve? Where is it located?
  • Which are the cochlear nuclei? Where are they located?
  • Where is the nucleus ambiguus located? Which cranial nerves does it lend fibers to?
  • What type is the solitary tract nucleus? Where is it located? Which cranial nerves does it lend fibers to? What is its upper part? Which nuclei does it lend fibers to?
  • Where is the spinal trigeminal nucleus? Where are the superior and inferior salivatory nuclei?

I made mistakes when saying where some nuclei were located. The picture I had in my head when answering was completely wrong and I didn’t catch it in time. When he corrected me, I quickly realized my mistake and drew where they were on my original, unfinished drawing. After a couple wrong answers, I was able to get myself into gear and answer the rest correctly. This is the drawing I am referring to:

Intro-5_labels

Histology Topic: Thyroid Gland

I love this slide, so I was so happy that I got it. It’s an easy one, yes, but it is also beautiful. I love the perfectly homogenous colloid sections in the slide. I mentioned that the colloid was thyroglobulin, a precursor for T3 and T4, which is secreted by the surrounding follicular cells. I then mentioned that there were parafollicular cells that secreted calcitonin. It’s funny because, while reviewing the slide, I’d thought to myself, “this is anatomy, so they probably won’t ask me what calcitonin does because that is more of a physiology question”. Even so, I decided to look it up, just in case. And guess what? He asked me! Unfortunately, I didn’t quite remember. I knew it had something to do with the level of calcium in the blood, but answered incorrectly about whether or not it was increased or decreased by calcitonin (it’s decreased). He also asked me the full name of T3 and T4 (silly me for only remembering the abbreviation). I could only manage “thyro…..” and he had to fill in “…oxine. Thyroxine.”. To finish off, he asked me a little about the gland: where it is located, what its structure is like (e.g. how many lobes), etc.

thyroid-gland-histology

Sensory Organ Topic: Organ and Pathway of Taste

Out of all the topics this one could have been, I ended up with something completely unexpected. The original topic I got was: organ and pathway of taste. But then he changed it. He said that he didn’t want the pathway and that I should present the development (embryology) of the tongue. Since it didn’t say “development” in the topic on the topic list, I didn’t think we needed to cover that for this semester’s exam. We had to know the development of the endocrine organs, central nervous system (brain and spinal cord), the peripheral nervous system, the eye, the ear and the components of hearing. The taste and smell sensory topics were only two topics (one each) on the topic list, versus the eye and ear which each had 11 topics. So, I had to pull up knowledge from last semester – again! Luckily, this was a topic that I had really enjoyed and understood. I was able to almost perfectly recreate the drawing I have in my second semester notes ¬†– thank goodness!

tongueembryo

In the end, he said that I was strongest on my first topic (accessory and hypoglossal nerves) and weakest on my second (cranial nerves) because I fumbled with the location of some of them. He also mentioned that I should know the full names of T3 and T4 and that I wasn’t so clear with the innervation of the tongue (I had said chorda tympani nerve but not lingual nerve for the anterior ‚ÖĒrds). Considering those factors together, I ended up with a 4. While I am so happy that I passed – and did well – I can’t help but feel a little guilty. There were so many topics I could have failed miserably on, not because I never went through them, but because I didn’t remember them well enough. But then I’m quick to feel like I didn’t deserve it whenever I pass… Skjalg is always reminding me that I am not an examiner, so I can’t know what it is like to assess a person’s knowledge. So, I worked hard and it paid off in the end, but is there a lot I need to review before being 100% competent at the material – you bet! At least I have all the notes I need to do so. This is the first time I have ever been able to make a complete guide for all the of topics. I know that will really help me later on ūüôā

Since then I have been: sleeping! I took a 3 hour nap when I got home and slept another 11 hours last night. I’m giving myself today off because I really, truly need it. Then from tomorrow, it’s biochemistry cram time! It’s my last exam and the “easiest” of the three we have this exam period. Finally, there is light at the end of the tunnel!

Foundation of Character

January 4, 2014 § 2 Comments

The days blend together as the 7th approaches. I have completely shut myself off from the world and moved into the guest room where there is no evidence of daylight or noise of the city to distract me. Many of us couldn’t wait for exam period – me included – I’m not so sure about that now. This part of this journey is a battle in the truest sense. It strips you of your strength, your confidence and your faith in yourself. It makes you doubt your ability to make it through and throws you naked and weak into the arena with your worst enemy, your self-critic.

In my favorite motivational video (which I’ve mentioned several times before) Rocky says, “It ain’t about how hard you’re hit. It’s about how hard you can get hit and keep moving forward, how much you can take and keep moving forward!”. When things are really hard, when I am seemingly completely devoid of strength, I think of that line. I envision each bad thought as a hit, some of them knock me to my knees and some knock me completely off of my feet. Then I envision myself getting up, staggering and bloodied, and waiting for the next one. It’s the hardest thing I know to keep pushing forward when you feel you have nothing left, nothing but a sliver of hope that your persistence will move you even just an inch forward.

While having breakfast this morning, I treated myself to a TEDtalk by Diana Nyad called Never, ever give up. In it, she talks about her experience swimming the 100-miles from Cuba to Florida at age 64. In the beginning, I expected to be inspired for a little while and then head on with my studying. But it ended up being more than that. She spoke of the times they had attempted to make the swim before, each of which they (her and her team) had failed. But she didn’t seem saddened by it. Instead, she spoke of her “failures” and how much they meant to her.

And as I said, when I turned 60,¬†it wasn’t about that concrete “Can you do it?”¬†That’s the everyday machinations.¬†That’s the discipline, and it’s the preparation,¬†and there’s a pride in that.¬†But I decided to think, as I went along, about,¬†the phrase usually is reaching for the stars,¬†and in my case, it’s reaching for the horizon.¬†And when you reach for the horizon,¬†as I’ve proven, you may not get there,¬†but what a tremendous build of character and spirit¬†that you lay down.¬†What a foundation you lay down in reaching¬†for those horizons.

Her comment about character really hit me. I have thrown myself completely into this. I sleep 7 hours and study the entire time I am awake. I’ve left the apartment exactly two times since Christmas: once to the store to get energy drinks and then on New Year’s to watch the fireworks at midnight. This is not how I would like my exam period to be, but I can’t change it. I can’t spend time doing other things because then I won’t feel like I gave it my 100%. The only thing that makes me feel better is studying. Giving myself more days to prepare for this exam only ended up with me using that time to read more, not to take a coffee break with a friend or even just go stand in the park for 5 minutes.

After all of that time and energy invested, the stakes are high. A bad outcome could make me feel like all of this was time wasted, that I could have used my time for things that returned on my investment. That’s where I would be wrong, because, no matter what happens on Tuesday, I will have gained. I have been forced to come to terms with my insecurities and to work on my ability to self-cope. I have improved my method of studying and learned how to turn off my perfectionist qualities. I have learned a lot¬†of anatomy (most of which I won’t be examined on – since we only get 4 topics – but am grateful to have learned regardless). ¬†So, in the video, when she said “tremendous build of character and spirit you lay down”, I felt proud. I felt proud and untouchable. And that, it what everyone should feel when they challenge themselves in any way.

Those are my ramblings for the night, hopefully it made sense (14 hours of studying does not make for a clear head) and hopefully the inspirational part made its way through that heavy beginning ūüėČ . Here is the video and below that is our topic list for this exam, so you can get an idea of what we are up against in anatomy this semester.

TopicList1ANA3TopicList1ANA2TopicList1ANA3

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