Q1 Begins!

With my mini-quarter now complete, I am diving into my first "real" quarter of medical school. Here is how my class schedule is shaping up so far:

Biochemistry
Medical Genetics
Developmental Biology
Practice of Medicine
Anatomy
Costs, Benefits, and Risks of Health Care
Healer's Art
PALS

It's a jam-packed schedule, but I'm excited about all my classes. There are also several lunch time seminars I'll be sitting in on, including Intro to Surgery, Intro to Internal Medicine, and Intro to Emergency Medicine.

Also, another ANATOMY UPDATE:
You can now quiz me on the thorax and upper limb. So basically the hand, arm, shoulder, heart, rib cage and lung. I know how to test if you have carpal tunnel syndrome, whether your dislocated shoulder caused nerve damage, and make sure you have a corotid pulse.

My Evolution into an AM Runner

It's come to this. I have finally given in to the pervasive idea that only by running in the morning can you ensure you will get a run in. For the mini-quarter I attempted to run after class, to workout at the gym at night, to run once I got home. Fail. Fail. Fail. If it ain't working, change it. So this morning I woke up, went for a light run, and voila, I fit my run into my day, before my 6 hours of class, before the evening OB/GYN interest meeting, before the interventional cardiology lunch time talk. I ran, I feel great, and I'm happy.

I also realized that it's not so much that I don't like running in the morning, it was pleasant today. I just HATE getting out of bed in the morning. There is nothing more satisfying then hitting the snooze alarm 10 times to me. This too can change, and today I only hit it twice and was out the door by 7:30. Desperate times call for desperate measures. I will only do well in medical school if I run regularly, thus my entry into the world as a newly minted AM runner.

Novel H1N1 Virus

Today I learned how to give a flu shot, I vaccinated someone and got vaccinated in return (with the seasonal flu vaccine). I learned a lot about the Novel H1N1 Virus. Right now the US government is prioritizing vaccination to certain groups who are at high risk. It appears that most of the public health community is on alert, ready to start vaccinating as soon as we get enough of the seasonal flu vaccine and the novel H1N1 vaccine.

Here at Stanford, all 1st and 2nd year medical students are being enlisted to vaccinate the entire Stanford community, all 30,000 or so that want the vaccine. I will let you know how it goes once we get started.

I also learned of the 3 key signs of influenza-like-illness (ILI): people must have a fever, and they must have either a cough OR a sore throat. If you're worried about catching the flu this year, stay away from people that cough (within 6 feet of them and you'll probably get the virus), and wash your hands regularly. Most importantly, don't touch your face! The best resource if you're concerned is the Center for Disease Control's website. They have weekly updates and more than enough information.

Survived Exams

I'm still alive. And I think I passed!

Sent from my iPhone
-Julia

Hey Mom, Look What I Can Do!

On Wednesday in my Practice of Medicine class we learned how to:

• Draw blood
• Give a PPD (TB shot)
  
• Give a shot into the muscle (IM injection)
  
• Measure blood pressure
• Measure glucose levels

I feel so doctorly after learning all of these, I love it! I practiced on my fellow med students, and in turn they practiced on me. It wasn't too bad at all, besides the fact that getting an injection of sterile water into the skin really stings. Please don't ever do it.

Limited time offer: Free blood pressure screenings for life to the first person to buy me my very own sphygmomanometer.

Anatomy Update

As you can infer from my previous posts, I really enjoyed the first few anatomy labs. Then came our past lab on Tuesday. In this lab, we needed to turn the cadaver over so we could access the back, and investigate the trapezius and latissimus dorsi muscles and various other things. I was very disturbed by the act of turning over our cadaver. For some reason, seeing the legs, seeing the body so lifeless, and needing to put so much force into moving it, made me acutely aware of what we were doing, that this was a real person. A person who walked, talked, maybe ran, told jokes, worked, had a family. Up until this point I have been able to trick myself into thinking of the corpse as a "cadaver", as "it", as a thing to be investigated and explored. At lab on Tuesday, the last thing in the world I wanted to do was explore. I think another part of it is the fact that we had to cut through so much skin. The last few labs we have been deep in the thorax, its much easier to dissociate from the humanness of the cadaver when you're holding their insides, and seeing organs in ways you never saw before. Skin is something very human and real, and I think I struggle most when I have to cut through the skin. I'm very grateful to have this opportunity, and today I was fine during anatomy. But I think I like working with living people a whole lot more than I like working with dead people.

Quote of the Day

"It's like studying human behavior in a burning building"

Dr. Brown on why it's bogus that so many of our cell culture studies are done in serum, which is cells taken from clotted blood, and is chosen so exactly because it is basically the universal signal for cell growth, and is something that normal cells almost never see.

A Startling Assertion

Dr. Krasnow finished his lectures today with the following statement:

"You now know more about molecular biology of disease than all the physicians you will work with"

Subsequently he encouraged us to take the lead in asking the difficult questions that link clinical presentation of disease to its molecular mechanism and cause.

Kind of awesome. Good thing I'm studying hard!

The Dish

The Dish is a 4 mile trail on the outskirts of the Stanford Campus. From the southern entrance, it is characterized by the Never Ending Hill, the Glorious Downhill, and the MoJo Hill (as named by yours truly). You can find deer (as we did today), lots of squirrels, bluejays, hawks, snakes, and mice.

The Dish owns me. It is a tough run, but I feel like each week I run it, I'm tackling it a bit more than it is tackling me. I thought it could be entertaining to share some of the thoughts that crossed my mind during my run this morning...

While conquering the Never Ending Hill:
"Kill kill kill the hill. Shoot, I think my chest is tight, maybe I have hypertrophy of my left ventricle. It would really suck to have a heart attack right now. Better be safe and walk. The nurse checked my heart the other day but I don't trust her. How can I weasel my way into an ECG? Maybe some cardiovascular studies need healthy volunteers. Need to check into that. Oh stop being a wimp and just run.

While coasting on the Glorious Downhill:
OMG is that a hawk? Nope, just a rock. Wow, I'm seeing things. I hope I don't have a retinoblastoma. Nah I don't. Downhill is my favorite, I love running, I feel so free. Oh shoot, there's the steep hill. Why am I doing this again? At 8:30 in the morning? What is wrong with me? Whatever, I can do short hills, just nail it.

While climbing the MoJo Hill:
Get your mojo. Go mojo go mojo go. Almost there, last hill. I love the last hill. I'm owning this. BOOYAH.

Today: 3 Firsts

1. Took my first patient history ever (I heart the Pacific Free Clinic)

2. Did my first blood draw ever

3. Chased by ferocious dogs on a run for the first time ever

Veins, Ventricles, Arteries, Oh my!

Are you a future cardiologist or cardiothoracic surgeon? If so, the following terms will just slip off your tongue... Today we got to cut through the heart, see the valves (amazing!), cut through the veins and arteries, saw through the rib and clavicle. A little gruesome, but an incredible learning experience. I now give you permission to quiz me on any of the following terms:

Left subclavian vein
Phrenic nerve
Thoracic duct
Coronary sinus
Atrioventricular Node
Mitral valve
Right internal jugular vein
Left common corotid
Great cardiac vein
Atrial appendage
Papillary muscles
Hemiazygous nerve
Brachiocephalic Trunk
Circumflex
Tricuspid valve

It's like learning a new language! I love anatomy.

Asha Medical Foundation

This evening I had the good fortune to listen to a talk by Dr. Kiran Martin, the Director of the Asha Medical Foundation, which is an organization that delivers health care to slum communities in India. Dr. Martin is a remarkable woman, she speaks with passion, has a clear understanding how to get results, and is motivated to make the most impact possible. She challenged all of us in audience (as we enjoyed the delicious Indian food), to do more to improve situations of those less fortunate than us. She spoke quickly, so I'll have to paraphrase her challenge:

"You can be the people with the inspiring vision, the credible vision, the moral authority. You can use your gifts to see that the shame of child poverty will not have the last word. This is my challenge to you"

In the last 21 years, Asha has been successful in creating a sustainable model that is not expensive, but gets results. They train community health workers (selected by those in the slum community) to do the majority of the medical work, health prevention, promotion, mid-wifery roles. They connect the communities to excellent referral systems to meet with medical specialists when needed, and focus efforts on education folks to take an active role in getting clean water, electricity, housing rights, sanitation for their community.

You can learn more about ASHA here.

Russian Ridge Hike

Natalia, Anne and I went on a hike in the Russian Ridge Open Preserve late this afternoon. It was awesome! We could see the Pacific Ocean, a panoramic of Stanford, and all of the peninsula. We saw a cute little mouse too.

Fresh produce rocks

One of my favorite things about living in Northern California is the fact that every weekend there are Farmer's Markets, overflowing with a variety of fresh cheap produce from the Central Valley. It is so much fun to go, try the samples (I had a pluot for the first time today!), and then come home and make some deliciously fresh and tasty lunch. Sarah and I pulled together a really tasty grilled chicken salad today with fresh lettuce, carrots, and heirloom tomatoes, we topped it off with strawberries for dessert. YUM!

For those who have never seen or heard of a pluot before, it's a cross between a plum and an apricot and is really tasty!

Stem Cells, Humans, and the Importance of Local Neighborhoods

I had an epiphany as I was sitting in my Cells to Tissues lecture earlier this week... See, when you learn about what goes on inside a cell, you realize that almost all stem cells have the same DNA inside of them, which means that technically they could be any other type of cell. What makes a stem cell unique is the environment it is in, its niche. There are certain characteristics of niches that turn on certain genes to make certain proteins, which makes a blood cell a blood cell, a skin cell a skill cell. We're realizing that we can manipulate the environment of the cell and change cells into different types of cells, which will no doubt lead to amazing therapies in the future.

So as I was sitting in class, I realized that if our cells evolved to be changeable and malleable, it reasonably follows that this could be very helpful too humans too. If you were to clone me, and put the two me's in two very different environments, families, ways of living, you would probably get two very different me's. In terms of my goals, values, beliefs, I would bet they would turn out to be much different depending on which "niche" I was put in.

Just like a blood stem cell differentiates into certain types of cells depending on which part of the bone marrow neighborhood its in, I think by and large we are who we are because of our local neighborhood, our families, communities and where we grow up.

H1N1 Rap

Awesome doc rapping about H1N1

Vintage Book I Want:

The Cell in Development and Inheritance.

Written by Edmund Beecher Wilson in 1911. He was the first person to recognize and understand that tumor cells have abnormal chromosome divisions by looking at cells under a light microscope. He's really the founder of cellular biology, and we still use his concepts and basic findings ALL the time today. How cool is that? I think this book would be a nice addition to my small but loved collection of old books, including a recent find at the Mt. Zion Medical Library earlier this spring (a copy of William James' seminal work in psychology, "Principes of Psychology").

Insane in the Pericardium

Today I cut out a human heart, and held it in my hands. I've never felt like I was on more hallowed ground. Very few people in the world are granted this opportunity to study true-life forms for the sake of some day hoping to save and improve the lives of others...Most people whose blog posts start with, "today I cut out a human heart" would be marked as serial killer status...Seeing the real deal makes me so motivated to study and make sure I know everything inside and out. It also makes me realize that our bodies are amazing, sophisticated rockstars.

Things I learned about the heart:

• It's big! At least in most people, its bigger than my hands folded together. One cadaver had a super tiny heart
• It can have things in it! Our cadaver had a pacemaker going through the superior vena cava
• Everything that surrounds it (muscle, pericardium) is very strong

I also ran intervals today: 800, 400, and 3 200's. It's a start. I will not divulge my times because they are embarrassing. But on the bright side, the Stanford track is beautiful!

PS. Follow me! I added a "Followers" gadget to the bottom right hand of the screen.

Hearing More than a Hearbeat

Check out this article (I'm quoted in it!) from Stanford School of Medicine about our recent Stethoscope Ceremony. The video is great too, it features Katherine and Duy, who were both on my SWEAT trip.

Update: For those too lazy to click on the link, here's my few sentences of fame:

“It’s a wonderful gift to receive as we’re starting out,” said Julia Pederson, 24, one of the new students who immediately took her stethoscope out of its box to listen to the heart of her 10-year-old sister, Abbey, sitting next to her at the dinner table.

A Harvard biology major, Pederson has spent the past two years working at the UC-San Francisco Breast Care Center helping to facilitate decision-making between breast cancer patients and their physicians. That work set her on the course to becoming a doctor.

“A lot of times I was working with patients when they were first diagnosed with cancer. It’s a time when people are so vulnerable,” Pederson said. “Making them feel like they are getting the best care they can helps with that fear and vulnerability. Being that first line of support is an awesome thing.”

Gross Anatomy

I hate the smell of anatomy lab, but I love anatomy. It is so novel, I do something new and learn so much each time. For example, today I sawed through the ribs, cut through arteries and veins, and held lungs in my hands (my double gloved hands, thanks to Naila's advice).

...Sure I cut off part of the lung that I wasn't supposed to, nicked the outside lining of the heart, and had to re-saw through the bone because I didn't cut it all the first time, and keep calling the internal thoracic artery the internal thoracic nerve, but that's the fun part, and now I know better. I am so thankful for this unique and slightly nauseating experience. The 3-hours in anatomy lab fly by, much faster than any of my other classes (though I'm enjoying them too).

Given my kindergarten-like cutting skills, and lack of knowledge of anatomy, I am even more impressed at the surgical skills of some physicians. How some doctors can do a heart bypass by integrating the internal thoracic artery into the heart is beyond me. Infathomable. Beyond belief. But I will get there. One day.