Wednesday, July 27, 2005

What residency are you thinking of going into?

The funny thing about studying medicine all day is that it forces me to think in such a way that I assume I will become a practicing physician. Getting my medical liscence for fun seems less and less likely, doing strictly clinical research seems more and more likely. This is partially Dr. Amy's fault, partially Piper's fault, and partially the fact that medicine is so damned seductive.

"Come... zsn... don't you want... to save a life?"

Fitting in

It's been an incredibly busy last week. We had the histology midterm today, and are currently deep into Head and Neck, with the exam on next Tuesday. Rather stressful. Still, we had a chance to go out for one of my classmate's birthdays.

To clarify things, my classmates and I actually get along pretanaturally well. for instance, this was the third time we've gone out to eat and had to split the bill by everyone paying cash. Normally this turns into a debacle as no-one has money and the person that ends up paying gets stuck paying way too much, but with this group, it was smooth as silk.

We were joined by three second years. Two of them are the TAs, who have calmed down considerably since the begining of head and neck. It's now much clearer that their threats are in jest, and they really do wish us well. The third second year flunked anatomy, and so she is retaking with us. It's so incredibly helpful to have someone like that around since she knows the ropes, is one of those people who knows everyone,* and is quite sympathetic to us because we are in the same boat. She's obsessed with setting my overwhelmingly male class up with the incoming first years and her class of second years. I think it's rather cute, but appreciate that getting set up with people will also mean that I get to meet people.

Whenever we eat, MSTP with MD (or perhaps messed-up with normies), the rivalry always comes up. The problem is that people with very different career plans are in the same classes together so there will always be some cross talk, but understanding that doesn't make it any less likely to occur. One of the reasons I chose to come here is that the MD/PhD program here comprises a REAL MD and a REAL PhD - that is, full degrees, with nothing cut out, and very few relaxed requirements. In one of my first posts, I mentioned seing a group of MSTPs in a second year medical class describing their patients, and noted that the preceptor didn't realize they were MSTP until they told him they were going into the PhDs rather than into the clinical years of training (3rd and 4th years of med school). I therefore take it as a priority to fit in with the medical school class.

Thus, it bothers me that the TAs talk about playing 'spot the MSTP.' I suppose the year ahead of us was incredibly cliqeish in class the first year, and may have been haughty, but the thing is that we too will stick out. Having taken anatomy and histology, we won't be taking those classes with our MD counterparts. Physiology and Touchy-Feely I may help make up for it, but if we're not in there bitching about our anatomy readings, it could be difficult to connect. Ultimately, I think I care more about getting some friends here than having my administrative quirks remain unknown.

* Part of the reason that she knows everyone (other than the fact that she is rather outgoing) is that she failed anatomy. Everyone knows that she failed anatomy, therefore she knows everyone, and seems to enjoy her noteriety. She described me as the 'most sarcastic member of the class' a high honor, seeing as how we seem to have been admitted on the basis of most sardonic wit.

Wednesday, July 20, 2005

Head and Neck I

This unit start was particularly tough. Partially it might be that head and neck are an extremely complex region, but more importantly, the proff and the TAs seemed upset for some reason.

I think my attitude about the last test, and that of my classmates ticked off the TAs. We dismiss the difficulty of the class they're took, even though theirs was more in-depth. They go out of their way to make things easy for us, and our ingratitude and whining won't and shouldn't earn us any points. I need to do something about this.

The problem is that the amount of material seems overwhelming, and if you add in a hostile learning environment, I might as well start packing now, as I (half-jokingly) threatened to do before lab today. However, lab seemed to go much better, everyone was calmed down, smiling and laughing again and proud of our ability to pick things up.

Even I'm amazed. Eight hours ago, I knew nothing about the cranial nerves. Now, I know their names, numbers, foramena, and something of their innervation. Cold.

Anatomy update

Just finished the lower extremity (thigh, leg, foot, bits of hip that have to do with moving same). Test was on Monday. Got an 86% overall*, which I was kind of disappointed with compated to my 93% on the first exam, but the TAs pointed out that this exam was purposefully made more difficult, and it's a pass/fail class with a 75% threshold, and most people would kill to get our grade distribution. According to them, the test was about relationships and anatomical reasoning, which is basically prequisited on us having the anatomy cold - to have done as well as we did indicates that this was the case.

Now on the head and neck. We're getting a compressed version over the next week and a half (test on the 2nd). So, rather than posting, I ought to be reading my anatomy book and browsing my Netter's. Best of luck, all.

*81% on the written, 100% of slide id, and 89% on the lab practical. The slide id and practical are more identification oriented, thus justifying my reasoning.

Tuesday, July 19, 2005


Like Bill Clinton, I believe abortion should be safe, legal, and rare. Putting aside how many that should be, if you had asked me to guess this morning, I would have said that there are about 100,000 per year. I was off by a factor of ten.

Turns out there were about 1,293,000 in 2002 (via AS).

This turns into an incidence of 20.9 abortions per 1000 women aged 15-44 per year. I have no idea why the statistics are presented in this fashion. It would be more accessible to present them as 2.1% per year, which translates to a 50% reproductive lifetime risk of having an abortion.^1 Compare that to the 13% total rifetime risk of developing breast cancer (NCI).

We watched a video in class today^2 that compared embryonic development of different vertebrates, showing how wildly different structures have a common origin. It struck me that all the embryos that were presented in this rather upbeat, positive video were, in fact, dead and never going to complete the developmental journey that they were being used to celebrate. I'm grateful to the embryos and their families for giving me the opportunity to see this, and I thought the video was outstanding overall, but that twinge of sadness...

^1 You wanna quibble over statistics? Ok. Not likely to be productive, but...
Quibble 1: Spock suspects that the eggs are more in one basket, i.e. the same women keep having abortions. This seems to be the case in New York City, but overall it looks like most women are first timers.

Quibble 2: Harpo asserts that relatively few abortions are done on upper/middle class white women. Clearly, gender is a key factor in who gets abortions. Minorities are over-represented. Those who are in poverty or near poverty receive about 60% of abortions.

Clearly, there are more abortion statistics that I can keep track of, but even if 'only' 1 in 3 women will have an abortion, that's still a ton of people.

^2 I believe the video was "Oddesy of Life" from NOVA

Saturday, July 16, 2005


This blog is intended to be half personal, half professional - that is, my reflections on my day to day professional student life should be the majority of the discussion. Here's something more personal - my personal pictures, on flickr, just to give you some visuals.

Thursday, July 14, 2005

By the way...

You may find yourself asking, "What's a medical student doing drooling over basic molecular biology papers."

Well, I'm a little MeST uP. (Pronounced "messed up").

You may find yourself asking, "What does that mean?" This is the short of it - an MD takes 4 years. A PhD in biology should, according to NIH, take 4 years. An MD/PhD takes (about) 8 years. At the end of this time you walk out with two doctorates.*

You may find yourself asking, "What can one do with an MD and a PhD?" The answer is this: Anything you fricking want. Seriously - you want to practice, go practice. You want to teach, go teach. You want to do research, of any kind, do so. You want to do some kind of bizarre hybrid in an effort to make all the years sunk into your degrees pay off? Go for it (It's difficult to do this well, but not unheard of).

*They take this very seriously at my institution. When you defend your PhD thesis, you do a hooding ceremony, graduation, parents come out, blah blah blah. When you graduate from Med school, you do a hooding ceremony, graduation, parents come out, blah blah blah. No requirements for either degree are waved. The idea is that we actually are earning two degrees, not two chunks of degree.

RNA pathology, dangit

One area of research that I've thought about getting into is non-canonical RNA, that is, RNA which is not tRNA, nor rRNA, nor mRNA. Recently, we've seen big developments in RNA interference (RNAi) where you add RNA to a cell to get it to shut down production of the complimentary gene (Footnote 1). That was fairly interesting, then I stumbled onto microRNA (or miRNA), which are small RNA produced naturally by cells which fulfill various tasks. Most of them are unknown, but one is known to be involved in fly eye development. On my interviews here, I talked to someone working on long non-translated RNA, and also varients to the old standbys. For instance, there are multiple different versions of each of the tRNAs in humans -> what do they do, why do they exist?

Anyway, I had an interest in RNA pathology, that is, finding RNAs that cause or are involved in disease. People laughed. They said RNA was either too fundamental (tRNA, rRNA) or too low copy (miRNA, other non-mRNAs) to have enough effect to be seen on a human scale. Well. Check this out. In summary, there is a cluster of microRNAs (mir 17-92)that, in combination with other oncogenes (namely c-myc) cause tumours to grow faster (Footnote 2). Very exciting. However, it doesn't seem that they know how this newly relevant miRNA oncogene does its thing. Maybe someone (hint-hint) should investigate.

Footnote 1: A short explanation of RNAi with most of the detail stripped out. DNA exists in a double stranded, antiparallel condition, like so:

W: Start->AGTCGTACC->End
C: End<-TCAGCATGG<-Start

We arbitrarily label the strands W and C so that we can keep them straight. Say that W codes for a complete gene, the sequence of which is: AGTCGTAC. When the gene is activated, an enzyme comes along and transcribes the gene, producing a transcript. The transcript is made out of RNA, which uses "U" instead of "T," so it would be:


This piece of RNA is called messenger RNA or mRNA, it completes its function by meeting up with the ribosome, which translates the RNA into protein, according to the genetic code. This particular gene would produce a protein whose sequence is Serine-Alanine-Threonine. This has all been known since the mid sixties, major snooze factor.

Here's RNAi -> is you introduce RNA that is complimentary to the mRNA, the gene is shut down. What does this mean?

The mRNA is: Start->AGUCGUACC->End
The complimentary RNA would be: Start->GGUACGACU->End
Wait, that doesn't pair at all! Except that, it does because the pairing is anti-parallel, like so:

The mRNA is: Start->AGUCGUACC->End
The complimentary RNA would be: End<-UCAGCAUGG<-Start

Note that the complimentary RNA bears an eerie similarity to the C strand of the gene, such that if you expressed the C strand, you would produce that complimentary RNA.

So, you have the mRNA, and complimentary RNA. What happens next? They base pair, of course. The product is double stranded RNA (dsRNA). dsRNA is never encountered in multicellular organisms, except for in viruses. Therefore, whenever your cells see dsRNA in them, they interpret it as viral RNA. They then produce enzymes that destroy the mRNA of the gene, and may completely shut it down gene. This is called interference (hence RNAi). In plants, once a gene is shut down, it never comes back. In humans, the gene is only shut down as long as you keep adding the complementary RNA to the cell, and the amount of interference is proportional to the amount of complementary RNA you add. This is great for experimenters, in that you can see what happens if you have a range of expression of a gene, as opposed to the simple on/off allowed by genetic engineering. It is somewhat bad for patients, because if you are shutting down a harmful gene by giving the patient complementary RNA, the effect wears off quickly, and you have to give them a lot of RNA to see an effect (people are trying this as we speak, btw).

Footnote 2: He L, Thomson JM, Hemann MT, Hernando-Monge E, Mu D, Goodson S, Powers S, Cordon-Cardo C, Lowe SW, Hannon GJ, Hammond SM. A microRNA polycistron as a potential human oncogene. Nature. 2005 Jun 9;435(7043):828-33.

PMID = 15944707

I applied to CSHL for grad school, didn't even get called for an interview. I know who Hammond and Hannon, and I wanted to work for them, and if I were... sigh.


I read the paper. Not bad. I mean, there are holes you could drive a truck through, but I'm still hugely excited. They want to rename their gene oncomiR-1 - that's oncogenic micro RNA 1. Woo. It's like Ras in 1982.

Sunday, July 10, 2005

In Soviet Russia...

Sorry, couldn't resist.

...not evil

Classmate 1: I need to relax this weekend

Classmate 2: Need a drink

C1: Smoke some weed

C3: Need something stronger. Get some heroin.

I: Sure, find the saphenous vein. Median malleoulus, 2 fingers up, 2 over, put in a line. You can run 500ml of heroin a minute.

C3: That's just twised.

I: Well, we haven't yet sworn to use our powers for good.

Saturday, July 09, 2005

What's in a leg?

When I tell people (as I just did) that we described the entire anatomy of the leg in three days, many ask me, as my friend Marc did, "is there much anatomy in the leg?" Ummm, yes.

How much?

Bones: 28 plus
Well, the hip (os coxa) is actually 3 bones, the illium, the ischium, and the pubis (aka the pecten). There's the femur, tibia, fibula, then the foot bones - talus, calcaneus, navicular, cuboid, 3 cuneiform (medial, intermediate, and lateral), 5 metatarsals, 14 phalanges, and don't forget the patella. Each bone has several parts which are signifiant because muscles attach there, or they articulate with other bones, e.g. the head of the femur, which is the ball to the hip's acetabulum, which plays the part of the socket.

Muscles: about 70
I'm not naming all of these, but from going through my atlas, there are about 70. Think about it, you can do some pretty amazing things with your leg, and for each of them, several muscles have to work together, many of which are unique to that movement. Something like walking is a lot more complicated than it seems, insofar as some little thing like being able to flex your toes when you push off makes your walking a lot more graceful.

Nerves, blood supply, venous return, blah blah blah: Lots more
Anyway, my point is not just that I have this really long vocabulary list that I have to transcribe to my 3x5 cards, quite the opposite. Flashcards do not help, because I have to be able to identify these structure on any body in the anatomy lab, in anatomical cross section, on x-rays (or CT, or MRI, or angiogram, or, or, or), and tell how they interact (e.g. illium and psoas muscles form up to make the illiopsoas muscle, which inserts on the lesser trochanter of the femur, the blood supply is whatever, the nerve innervation is such and such with a given set of spinal segments), and how they can and can't be injured (i.e. a fracture at the head of the feumr is unlikely to disturb a muscle like illiopsoas that inserts lower in the bone - at the lesser trochanter).

People who know me know that I sail through most academic things. They may wonder why I have to study constantly for this, and this is why.

Anatomy update

Just finished the third week of anatomy. Started with a test on the 'upper extremity,' and then we covered the entire 'lower extremity' (what a normal person might refer to as the 'leg') in 3 days. I've never studied so much in my life. On the other hand, I have exactly one responsibility - pass anatomy. If I'm doing that, nothing else matters (including getting my window fixed). Thus, I can justify sleeping 9 hours a night, because it improves memory.

Anyway, despite doing the leg in three days, the test isn't until next monday, so we're going to spend the next week being lectured by leg surgeons, radiologists, and other clinical types on the leg. This is good partially because it helps you remember, but it's bad in that whatever the clinical guys say is testable. For instance, an orthopedic surgeon came in and told us about different types of nerve damage - nerves can be bruised, they can be cut, or only the conducting part (axon) is cut, while the insulation (epineurium) is fine, or it can be pulled out at the spine. Then he chuckles and tells us, "Of course, we don't call it that, we don't want anyone to understand." All of a sudden, we have to know neuropraxia, neurotmesis, axonotmesis, and avulsion (in that order).

Friday, July 01, 2005

You're in the city now!

I've got to eat just like anyone else. So, despite my dissection schedule, I put aside some time today in order to go grocery shopping. I unlocked my car, opened the door, and was shocked to find some kind of white powder sprayed all over my seat. On closer examination, I realized that the powder was actually the facets of small, otherwise transparent cubes. Then I noticed that the passenger side window was missing.

I circled around to the passenger side, and gaped at the fractured remnants of the safety glass. I looked inside and saw that window sprayed all through the car. Damn.

I looked around the inside, trying to find something missing. Harry Potter on tape - still there. Car CD player - still there. Change - still there. Then I remembered. I had been leaving a few bucks in the cupholder to pay tolls with. That was the only thing missing.

Someone broke my window for $3.

On the other hand, I'm keeping the brick they tossed in as a souvenier. Also, my roommates helped me clean up, and we went out afterwards for diner food to celebrate. Since I've been having trouble making friends with them, the progress seems worth the cost. One of my roomates thought the glass actually looked rather pretty, and insisted I get a photograph. The almighty brick lurks in the background.