Friendships and Hyperkeratosis

"We can't have the happiness of yesterday without the pain of today. That's the deal." -Joy Gresham, Shadowlands.

Today in neuro, we discussed the books that we had read on Alzheimer's. If you have been following my posts, you know that mine was Losing My Mind by Thomas DeBaggio. I figured that it would just be a simple discussion about the sad nature of the disease and then I could go on with my day. Although the book was interesting and poignant, as someone who has no immediate family afflicted with this disease, I thought it wouldn't be a big deal to discuss it.

I was wrong. Dr. Norden has this way of approaching a topic so as to directly relate it to your personal life. I had never thought of having an individual that I love slowly slip away and become someone that they are not. Forty years of marriage obliterated by a simple little illness. How vulnerable we become when we truly love someone.

My friends in my pictures might be gone tomorrow and with each new friend, my odds of being hurt are increased. Should I gamble?

As a practicing physician, the stakes will be even higher. How can I empathize effectively and not be injured emotionally with every death on the wards? As I progress through medical school, the emotional callous is slowly forming. I am aware of this change and grateful to Dr. Norden for stressing the importance of emotion. What a shame to blindly pursue clinical competency at the expense of compassionate healing.

Cadavers and Cruises

“Being dead is not terribly far off from being on a cruise ship. Most of your time is spent lying on your back. The brain has shut down. The flesh begins to soften. Nothing much new happens, and nothing is expected of you.” –Stiff: The Curious Lives of Human Cadavers by Mary Roach.

I love this book. Not many attempts at humor make me laugh out loud, but I was in tears throughout most of Ms. Roach’s hilarious tome. I first discovered her work in Reader’s Digest; her “My Planet” column is one (albeit small) highlight of my month. Although I can’t quite discern what makes her so funny to me, I think it’s her tone. The straightforward sarcastic nature of her columns is carried over into Stiff and makes for one of the most entertaining reads of my first year of medical school.

On a side note, on page 56 of the book, she quotes Dr. Art Dalley, Director of the Medical Anatomy Program at Vanderbilt University, who, by the way, happens to have taught me anatomy.

In this same chapter on medical cadavers, she is able to capture the awkward feelings that first year students often have from dealing with a dead human for hours on end. (Not to mention exposing the myth of the “well-endowed” cadaver.) As her anecdotes continue, she explores other aspects of cadaver history including human head transplants and medicinal cannibalism with humor black as night but funny as anything. Required reading for the first year student.

Wheelbarrows and Neurofibrillary Tangles

The Red Wheelbarrow

So much depends upon
a red wheel barrow
glazed with rain water
beside the white chickens

-William Carlos Williams

Words that are no doubt familiar to many of you. I have heard it said that context is everything, and, while this poem certainly has significance to the human existence on its own merit, the context that I encountered it in today was both arresting and profoundly moving.

For our neuro class, we are required to choose a book that deals with the issue of neurological disease. Dr. Norden has stressed in class the profound impact that these problems have on the lives of those afflicted and their families and she wanted us to have some insight into their stories. I chose Losing My Mind by Thomas DeBaggio.

Mr. DeBaggio is one of the unfortunate sufferers of early onset familial Alzheimer’s. Losing My Mind chronicles his descent into the shadows of the disease with stark detail and frank honesty. In reference to the poem above, he cites the verses as a reference to “the relevance of small, familiar things, how they comfort and steady our lives.” These small familiar things were slowly being taken away from him as the tau protein in his brain became tangled knots of useless protein. Barriers on the path to memory.

I have discussed before how frequently I encounter difficulty when trying to relate to my patients. One of the exceptional remedies to this, I believe, common malady among physicians is the emerging genre of medical media. Through the stories of Mr. DeBaggio and others, I feel that I finally able to understand just a little of how they experience their illness. Perhaps true empathy depends on these brief glimpses of the red wheelbarrow.

Kupffer Cells and the Fornix

Full disclosure…I can be a complete nerd. That being said, I get out and party with the rest of them. Last night at the John Mayer concert, due to my unfortunate reference of some random fact from path as a joke, I was routinely and, for the most part, rightly lambasted by my fellow classmates. No one wants to hear about school when we are supposed to be partying to forget our crazy lives.

My question is: How can we expect to separate our lives from medicine when medicine is our life? I know this is an important part of being a balanced individual in any profession. Certainly the idea of separating business and pleasure is not a new one. Maybe the conspicuous absence of a significant other makes my life more “educentric” than it would be otherwise. It just sometimes seems like learning this is more difficult than memorizing the clotting cascade…guess it’s all part of the medical maturation process.

Autoantibodies and American Football

Crippling deformity, premature mortality, excruciating pain: Autoimmune diseases aren’t for wimps – Dr. McCurley. Basically, when you have one of these diseases there is a civil war going on inside of you and you are powerless to stop it. It was sobering to sit in class today and think about the thousands of people afflicted with rheumatoid arthritis, lupus, or scleroderma. As a student, I desire to relate to my patients and understand their conditions, but I can’t imagine what it must be like to experience terrible pain with every minute movement of your tiniest joint.

Judging by our lectures this morning it seemed like there isn’t much modern medicine can do for these patients. However, just recently, the NEJM (basically the “Bible” of medical research) published some encouraging articles concerning new drugs for the treatment of rheumatoid arthritis.

I think it is so amazing how much medicine has progressed in the last fifty years. Just yesterday Dr. Norden (my neuro prof) was telling us how all the information we know about communications in the brain (synapses for all you budding MDs) was less than fifty years old. How awesome that science has grown at such a tremendous rate. I am involved in some research here at Vandy and uniquely driven to learn more because I know that, ultimately, my findings may actually contribute positively to the quality of someone’s life.

So the NEJM article was a bright spot in a somewhat sad day, but tonight a group of us (meaning med students) are going to the John Mayer concert in Nashville. Should be fun, but since I didn’t have any pics for you yet of our auditory adventure, I wanted to post a pic collage I made of our VMSI vs. VMSII Annual Football Game. Vandy is full of traditions; this being one of the more violent ones. At the beginning of each year we all get together on one of the intramural fields and the girls of each class cheerlead while the guys pummel each other (Don’t get all worked up about gender stereotypes, a role reversal game is planned for next week). Good clean American fun!

Check back later tonight to find out about the concert. Surprise…some of us med students actually do go out.

Neuronal Cell and Tired Bodies

Tangled axons shooting off synapsing with distant dendrites; my day was as chaotic as this picture (more on that later). Let’s start at the beginning: neuroscience. While this might not seem like your typical beginning, I have quickly found out that everyday in medical school has some kind of atypicality about it.

On Thursdays at Vandy we have neuro (as all of us MD wannabes call it) from 8:00-12:00. Our professor, Dr. Jeanette Norden, is an amazing lady. Every Tuesday and Thursday she inspires me to become a neurosurgeon.

Did you know that there are over 100 billion neurons in your brain and that each one of these cells has a specialize function and characteristic appearance (See fig. 1 above)?

The level of complexity in the brain awes me every time I go to study. Like Dr. Norden always says, the fact that any of us developed normally is a miracle. Simple but profound.

After lunch, we watched a video on the Tuskegee Syphilis Study and had discussion groups about the ethical issue surrounding the study. This experiment was documented in the Pulitzer Prize winning play Miss Evers' Boys by David Feldshuh. As someone from a neighboring county in Alabama, it was hard for me to hear Feldshuh’s story. I know how insidious this problem still is in the South and not much can make me angrier than the thought of racism to anyone in any form.

On a happier note, my new 20GB 4G iPod came in today and I am in love all over again. Did you know that an iPod can give you a better body? I am living proof. Working out is fun when you have a soundtrack.

After working out, I went to sing in Immune Response, our men’s choir at the medical school. It’s my first time and I am really excited. I was in glee club all four years at my undergrad (Asbury College) and the songs we are singing, Coney Island and For the Longest Time, are a lot of fun. If you have suggestions for us, just post a comment and let me know.

Working out was immediately followed by Bible study, shower, dinner, laundry, and an intense study session. Like I said, crazy day…but awesome…visual metaphors are cool.

Little Bit of Intro

Rob Thomas, VMSII. My name and the little acronym that will define much of my life for the coming year. Letters that signify my place as a second year student at Vanderbilt Medical School. I figure that most people know someone who has been through the experience of a medical education. Still, as someone in the midst of it all, it seems like such an amazing experience that I want to share it with whoever is interested. So whether you are a pre-med student looking for some insight or simply an interested observer, my goal is to give you a glimpse into the amazing and challenging reality that is my life. If that sounds interesting to you, check back soon for updates. I am really excited about what this year has in store for me!