Speed of Light

Things this week have been going by so fast I'm surprised that I've even found the time to write an entry. I've studied all the material that my brain will hold for today, so I need to get away from the lecture notes. After a while, no matter how hard you concentrate, there comes a point when you turn the page and have forgotten what you just read on the previous five pages. That's one of the reasons why it's better to study everyday rather than trying to cram it all in in just one day.

On Tuesday we had our clinical pathology final in the morning and then we had our frozen section practical and gross dictation practical in the evening. The art of taking a frozen section is really tough to master! Before Tuesday I was in the gross laboratory at night for a couple of days and there were multiple times where as I was cranking the wheel the blade cracked the specimen right in half! It's game over if that happens in a real situation. I couldn't for the life of me understand why it was happening. After I searched some on the internet, the freezing gel, "Optimal Cooling Temperature", needs to solidify just right to ensure smooth cutting. I was cooling the block too much and it was shattering the whole specimen when I cut into it. It's a good thing that I learned that through experience rather than have that happen to me on my rotations next year. I'd rather make all of my mistakes now.

Yesterday was also a big event for us. We finally received our laboratory coats at our white coat ceremony. Although finals are still ahead of us in two days, it's too late for any of us to fail now. It was a really nice ceremony and I had the chance to see the family members of many of my classmates. Of course, West Virginia was too far away for my family in California to attend, but I still felt as if I was surrounded by family. I'm sure that they are happy to see my progress through the program.

The lab coat seems to be both a blessing and a curse to me.
It's nice to see my progress physically manifest as a lab coat. I won't lie in that the lab coat is a kind of status symbol. But, what weighs on my shoulders more is the amount of responsibility that wearing the lab coat entails. When putting on the lab coat it felt as if now I had entered into a new world of responsibilities and mistakes would have much higher and real costs than before. My biggest fear right now is making a mistake that will impact someone's life negatively in a huge way. (Something I did or didn't do to cause the pathologist to misdiagnose our patient.) The most that we can do is to do our best, but there may come a time where my best is not enough to avoid making a mistake. In a just world, our mistakes would only negatively impact ourselves, but there are situations in which our mistakes negatively affect others. I'm certain that the lab coat will serve as a 'Sword of Damocles' that will remind me be to be ever vigilant. But, in a sense, the lab coat is more ominous than the 'Sword of Damocles'. Our mistake causes the sword to fall not on our own heads, but on the heads of our patients.

Another full day of studying awaits my classmates and I tomorrow. Just a few more days and we'll be finished with the semester. I'm looking forward to it!

Back From Break and Just a Few Big Things Left To Do

It's already been one week since we've been back in classes and things are moving very quickly. Even our Thanksgiving Break moved quickly! It was a well needed time to just relax before the last dash to the finish line. I’m disappointed I didn’t get as much done as I thought that I would. I had hoped I would study the lecture material in preparation for finals but the only thing that I got done was a microbiology report.

Our extra credit microbiology report was open-ended so I found it to be quite interesting.  We just had to write a report on how the field of microbiology affects the field of pathology. The most obvious choice would be to write a report on all of the different microorganisms that cause disease in humans, but I like killing things much better, so I wrote about all the different ways to kill bacteria in the surgical pathology laboratory. Basically I covered antiseptics, disinfectants and sterilants. I went in to the pathology laboratory at Ruby Hospital and looked at all of the chemicals they use in the laboratory to clean and to protect us from catching the bugs that our patients have. It turns out the active ingredient in the majority of disinfectants used there is n-alkyl dimethyl benzyl ammonium chloride. It sounds dangerous, but it’s only dangerous for the bugs. I can only imagine what it’s like to be a happy bacteria hanging out on a contaminated bench and then to see a flood of toxic liquid coming at you like a tsunami. The molecules insert into the bacterial membrane and disrupt it, so it’s equivalent to being… liquefied. Indiana Jones Raiders of the Lost Ark style.

In other big news this week, we’ve finally found out our rotation schedule for next year! My classmates and I have been waiting for this moment because the hardest thing to do has been finding a good place to live. Our housing in Charleston, West Virginia is provided for by the kind pathologists who work there, but that still left the monster of Pittsburgh to deal with. Here’s what my schedule is for next year.

1/3 - 1/27 University of Pittsburgh Health Sciences Tissue Bank (Shadyside Hospital), Pittsburgh, PA

1/30 - 2/17 UPMC Magee-Womens’ Hospital Surgical Pathology, Pittsburgh, PA

2/20 - 4/6 West Virginia Deputy Chief Medical Examiner’s Office, Morgantown, WV

4/9 - 5/4 Allegheny General Hospital Surgical Pathology, Pittsburgh, PA

5/7 - 5/25 Ruby Memorial / West Virginia University Healthcare Surgical Pathology, Morgantown, WV

5/28 - 6/15 UPMC Presbyterian Autopsy Pathology, Pittsburgh, PA

6/18 - 7/13 UPMC Childrens’ Hospital Surgical Pathology, Pittsburgh, PA

7/16 - 8/31 Thomas Memorial Hospital, South Charleston, WV

9/3 - 10/19 UPMC Presbyterian Hospital Surgical Pathology, Pittsburgh, PA

10/22 - 12/14 UPMC Shadyside Hospital Surgical Pathology, Pittsburgh, PA

You may have noticed something from the schedule above. There are no more breaks! We’re going to be kept as busy as bees, but it’s a good thing because this is the actual hands on experience that we need to be prepared for the working world. I’m very excited to be starting rotations and can’t wait.

Before that though we’ve got to survive finals. Next week we have one final and a practical, then the next week after that we have three more finals. It’s going to be a lot of cramming, but all I can think about is not having to take another traditional lecture course for the rest of my life. Hopefully. That reminds me, I need to stock up on some caffeinated green tea for these next two weeks.

Green tea is my anti-drug.

Today’s going to be a busy day as well. After all of our efforts, my classmate Prashant and I have decided on an apartment in Pittsburgh, so we’re heading there today to hand in our paperwork. All should go smoothly. The new place we’ll be at is located outside of downtown Pittsburgh, which will make the commute a drag, but the price was reasonable. The costs should come out to be $695 for a one bedroom apartment, with everything except for electricity, internet and TV included. There’s a bus stop right outside the apartment area that goes to Pittsburgh, but I’ll be carpooling with Prashant as much as possible. My challenge is to prove that going through the WVU PA Program without a car is possible. Of course, I'll be paying gas money. So far so good.

Woohoo! Thanksgiving Break!

It's not often that we get a whole week off from school so my classmates and I are overjoyed that we get the week off. Although most of them have left Morgantown to be with their families or are vacationing in warmer climates a few of us will be here in Morgantown. It's been gray all day and now it's raining, but nothing can dampen my spirits.

It seems contradictory to be in such jubilation if going to school is so wonderful. School is going along just fine and although I enjoy studying, studying for tests isn't all that enjoyable. I like WVU and the PA Program here but as I've said before, even people like Tiger Woods need to take breaks from golfing.

Nonetheless, I will still get some studying done this week. There's a 4-5 page microbiology report that I'll be writing and a couple of other subjects that need some studying up on. Once we get back to school we should only have a few weeks left until we are finished with the year. And that means we'll also be finished with classes! I can't believe that this could possibly be the last time I sit in a classroom and take a traditional course. Sure, learning goes on, but my classmates and I have been in the educational system for so long (the majority of our lives in fact) that the classroom environment has become something of a second home. I need to rent a 'mental U-Haul' and make the transition from my former home, the classroom, to my future home, the laboratory.

My roommate has invited me to spend Thanksgiving with her and her family. I'm looking forward to seeing everyone and eating some tasty food. I'm fortunate to have found such a kind roommate.

This winter break I'll be looking into the immigration and naturalization process so that Hanako and I can finally be together again. It's been six months now since we've last seen each other, but thanks to technology, email and SKYPE it feels like we aren't too far apart. I'm still worried about her situation because radioactive elements are still being emitted from the nuclear power plant and are possibly leaking into the ground water. I'm also very disappointed that the major media outlets have completely ignored Fukushima and kept everything hush-hush. I'll bet that the majority of people don't even realize that Fukushima is a level 7 nuclear accident, the highest rating possible and on par with Chernobyl. There are so many things in this world that I want to fix and set right, but I realize that the only thing I can do is to remain vigilant and care for my friends, family and those who will lend an ear.

In the meantime, I have some relaxing to catch up on.

Have a great Thanksgiving everyone!

There's Never a Good Time to Get Sick

I came down with a cold yesterday and it's just in time for my test tomorrow in laboratory management. I'm actually not too worried about it because my grades in that class have been fairly solid and I would have to flunk it for it to have a significant impact. But nonetheless, despite our two big tests last Friday and on Monday, the study material is once again piling up.

For me, the worst part about having a cold is not the impact that it has on your health, but how the cold disables your normal functioning. This is only the second cold that I've gotten this year so I don't get sick often, but when I do it just saps all of my precious energy. Precious energy is what is needed for studying.

Yesterday, as I was walking home from school after studying late in the scope room, my whole body just felt so exhausted that once I arrived home I couldn't study anymore. Later that night my pharynx began to get sore and I knew by midday today that I was sick for sure. Thankfully, I don't have any cough. Today after school I tried to catch up in the scope room again what I wasn't able to complete yesterday, but I was just so exhausted from the cold that I couldn't concentrate. No matter how long I stared at the slides I couldn't connect the dots or recognize what I was supposed to see. So after about 15 minutes of sitting listless I decided to head home, call it a day and try again tomorrow.

In high school, when our class graduated, my friend received an award for "Most Likely to Make a Cure for the Common Cold." He's studying physics now, but I need to pester him to hurry up on that cure.

Fingers, Abuse and Blood, Oh My.

Despite the misleading and grisly title this entry has little to do with what you're probably thinking.

So we've finished a big endocrine system physiology test today on Friday just in time to study for another big microbiology test on Monday. But at least this short break has given me enough time to write a little today. I focused most of my efforts this week on studying for the endocrine test today and it paid off well, but to my detriment a huge 16 lecture microbiology test awaits me in just three days. So, I already know what I'll be doing this weekend. In a twisted way, one perk of being in graduate school is that you usually know your plans are for weekends. Studying.

In addition to our normal studying, we've been busy fulfilling the requirements for working next year in Pittsburgh. We had already done our fingerprint requirements and vaccinations before we entered into the program, but unfortunately those results aren't transferable to Pennsylvania. So we have the pleasure of doing it all over again. Our program has switched over to a third party this year who will store all of our information and release it to any organization that we authorize. That third party is "Certified Profile" and we scan and submit our required information to their website. I believe that the PA students for next year in January 2012 will be going through Certified Profile as well.

There are a number of things that are required before we can start our clinical rotations. The hospitals want to make sure that we aren't child molesting, disease carrying ex-convicts. One would think that being in a Master's Program would pretty much be proof enough that you have no major offenses (after all how would you have been admitted to the program in the first place?) but rules must be followed for the sake of rules it seems.
The four requirements are:
1) Pennsylvania State Background Check
2) FBI Finger Print Background Check
3) Pennsylvania Child Abuse History Check
4) Proof of Immunizations for:
     -Measles, Mumps, Rubella (MMR)
     -Varicella
     -Meningococcus
     -Tuberculosis Skin Test (two PPD step test)
     -Polio
     -Tetanus, Diptheria
     -Hepatitis B

Hence, the title of this post.

In between our studying and exams and classes we've been getting these requirements done one-by-one.

1) The Pennsylvania State Background Check was the easiest. It was just a simple matter of printing out a form, sending it in the mail, waiting for the reply in the mail, scanning it and uploading it.
2) For our FBI Background Check, we needed to get our fingerprints done at a place certified to carry them out. There are a number of places in Pennsylvania which will take our fingerprints, but the most convenient place for us was in Washington, PA. There's a place there called "Mail Boxes Plus More" and it's located in a renovated train station, so it's got an awesome historical feel to it. They were open on Saturday so that's the reason we decided to go there. Anyways, the finger scanning laser machine was having trouble for the first customers but once it warmed up we got ours done in about 7 minutes each. I didn't know it but there's a special rolling technique to having your fingerprint scanned. You've got to roll with the right force, at the right angle and at the right speed or you aren't rewarded by the satisfying beep of success. Finger rolling is certainly an undervalued art form and deserves further study.
3) The Child Abuse Form was easy to do, just like the State Background Check. We just filled out a form, sent it in the mail, waited a week or so to get our results, scanned the result and uploaded it to the certified profile site.
4) Immunizations were a pain to do, but I am happy to say that today I should be finally finished with all of them. Because the cost of these immunizations was prohibitively expensive here in Morgantown, we drove to Fairmont to the clinic to get them done. The clinic has some of the nicest staff that I've ever met and it was a pleasure to be there. It's located just across from Fairmont State University and is called Monongahela Valley Association of Health Centers. In addition to our immunizations, I had some blood work done at the laboratory there on Wednesday and got my results today.

I've always had high cholesterol. Despite my slim BMI of ~18.5 my cholesterol has been over 200 for my entire life. Way back in early May I had my cholesterol done and didn't like my results.

                                                  normal
Total Cholesterol - 210 mg/dl     (<200)
Triglyceride -         163 mg/dl     (<150)
HDL Cholesterol - 35 mg/dl       (>40)
LDL Cholesterol -  143 mg/dl    (<130)

I was glad that my total cholesterol was down from around 230 earlier, but I still wasn't satisfied. I decided to eat less fattening foods, exercise more and take fish oil tablets. I'd eat more fish but it's just too expensive to eat a serving everyday, and although I love to eat tuna I don't want to introduce heavy metals (within reason) to my body. In addition, with the nuclear power plant in Fukushima continuing to spew radioactive cesium, iodine and even more harmful isotopes into the Pacific Ocean I'm even more wary of eating seafood. (I just hope that the fish oil tablets come from fresh water fish.) I had changed my daily regimen and it looks like it had a positive effect! My results that I got today are as follows:

                                                  normal

Total Cholesterol - 205 mg/dl     (<200)
Triglyceride -         85 mg/dl       (<150)
HDL Cholesterol - 46 mg/dl       (>40)
LDL Cholesterol -  142 mg/dl    (<130)

I can't be sure which change to my lifestyle brought about the most change, but I believe that the dramatic drop in triglycerides and slight rise in HDL are due mostly to taking the fish oil tablets.

BUT!

The physician who saw me had the foresight to order a variety of tests on my blood while I was getting my cholesterol checked and I found out that I have my first deficiency! (At least that I know of.) I don't know why I'm excited over it. It must be because I'm always looking to improve my health and now that I know about it I can do something about it.


It turns out I'm quite deficient in vitamin D (20.6 ng/ml, normal 32-100). We just covered vitamin D on our endocrine physiology test so I know quite a bit about it still. Vitamin D mainly comes from our skin when we're exposed to ultraviolet radiation, but it can also be found in fish, eggs and some meats. Well, I don't really get much sun exposure because when it's cold here (everyday in the Spring, Fall and Winter) I wear a sweater and pants. I also don't eat much fish (too expensive), eggs (too much cholesterol), or meat (too much other bad stuff).


My deficiency is such that I have a prescription for vitamin D now. I'll pick it up tomorrow in between my studying for microbiology.


Vitamin D deficiency is usually associated with impaired intestinal absorption and renal re-absorption of calcium and phosphate which are needed for your bones. I'm glad that it was caught before it developed over the course of many years and I suffered an unexpected fracture. In the end, I've got to thank having all of these extra requirements for going to Pittsburgh. There's a bright side to everything.

Brrrr.

This month the weather has taken a turn for the colder and with it my vigor to study hard has been sapped. I've always disliked the cold because it just paralyzes my muscles. It's bad when the weather is close to freezing and you want to go for a jog, but it's even worse when your hands are so cold you can't write with a pencil or type on a keyboard very well. So, I've moved my studying from my desk and into my bed.

Studying in bed is great and now I have an excuse to do so. My electric blanket keeps me comfy, my stretched out legs have plenty of room to move around and my bed isn't too cluttered because I'm on a queen sized mattress. At night I share my bed with my binders, textbooks and notebooks by my side. How very fitting for the life of a graduate student.

Tests are a constant presence in my mind. We have been having at least one per week and it seems that as soon as we finish one we barely have time to draw breath before turning our attention to the next test. Next year during our rotations we're only supposed to have one test per month, so it will give us more leeway to study what we'd really like to. For example, right now I'd like to review some anatomy that I learned during the spring semester and create some more digital flash cards. But I realize that if I turn my focus towards anatomy, it's not going to help me on my microbiology test in three or four days from now. It's like learning or relearning old material kicks out the new material  in my head. Wouldn't it be great if our minds had the storage capacity of a computer? As long as I wasn't stuck with a 1.4MB floppy disk for a brain, I'd be able to absorb and recall all of the information that I wanted to.

Among all of our classes this fall semester, I'd have to say that my favorite has been our microanatomy course. It's not easy and there's a lot of memorization, but looking through the microscope is like delving into another world. Histology is quite bizarre when comparing what's on a slide to what we see in our everyday life. Pathologists have quite the imagination when they say something like a cell pattern has a 'starry-sky' appearance or a nucleus has a 'Pince-Nez' appearance. (Usually they don't look anything like their descriptors. Perhaps these pathologists breathed one too many formalin fumes during the discovery process.) Anyways, this class is starting to affect my everyday life. Whenever I see something that has a strange pattern to it I'm reminded of all sorts of diseases. The wallpaper in my room looks hemorrhagic and papillary with nests of poorly demarcated cells surrounding capillaries. I'm surrounded on four sides by a huge inverted papilloma covering the walls of my room.

Dress Code and Other Thoughts

I can't remember where but I learned a saying a long while back that goes something like, "The clothes that you wear are a reflection of your heart." Since then, I've tried to dress more appropriately for each situation. It's not a requirement at WVU that you dress formally, but my daily attire is usually a dress shirt with black slacks and black dress shoes. I probably dress more formally than other students here, but I've never felt the need to wear a tie as part of my daily routine. Many people here wear t-shirts, shorts or jeans to class, which is just fine with me. It's definitely more comfortable attire than what I wear. Students wearing scrubs or white lab coats are also commonly seen.

Friday we had two tests and tomorrow, Monday, we have another one. I'm about all studied out. It always seems that once you reach a threshold no amount of further studying is going to help you. I think of it as diminishing returns for each extra hour invested past your limit.

I never realized how big football here was until this summer. Walking around town on a game day is like entering another world. The sidewalks and parking lots become crowded with people dressed in blue and yellow and the smell of hot dogs permeates the air. Tailgating is almost like a religious ceremony here. I've never really been interested in watching sports or attending a sports game. My father follows sports intently, so I'm not sure why those genes weren't passed down onto me. Rather than watching other people play a sport, I'd rather just play the sport myself. I can't live my life vicariously through the players on the field. I enjoy my life too much to be concerned about whether a player can catch a ball 70 yards down the field with two opposing players trying to tackle him. Getting together with friends and family and enjoying watching a football game is perfectly fine. But I'd rather get together with friends and family and just have fun over a game of Texas hold'em, hearts or Egyptian War.