I'm Going Slightly Mad

Well -- one more final to go. It's hard to believe this juggernaut of a semester is almost over. In light of today's title, which is not much of an exaggeration to be honest (sleep deprivation and mental overload), I thought I'd highlight Brian May, a true renaissance man who is not only a iconic rock star but a full-fledged scholar as well.

Prior to his rock band fame, Brian was an aspiring physicist, studying at the Imperial College London, and graduated with a Bachelor of Science Degree in both Physics and Mathematics. He then proceeded to make his way towards a PhD, but abandoned his scholastic endeavors when Queen started to become successful. 30 years later (and an estimated 300 million worldwide albums sold!), Brian returned to his research and completed his PhD thesis, officially graduating at a ceremony held in the Royal Albert Hall in May 2008. He also became the Chancellor of Liverpool John Moores University in April 2008, taking over for Cherie Blair, the wife of former British prime minister Tony Blair.

Brian in guitar hero mode:


Brian in full academic regalia:


In a word -- Brilliant!
Here's to you Dr. May...



Honorable mention goes out to Tom Scholz, guitarist and founder of the band Boston. Tom attended M.I.T. on a full scholarship and graduated with Bachelor's and Master's degrees in Mechanical Engineering. He went on to work for Polaroid and has 34 patents to his name. While still at Polaroid, Tom recorded virtually all of the first Boston album in his basement -- an album that went on to sell more than 16 million copies, which I still believe holds the record as the best selling debut album of all time.

Tom the guitarist:


Tom the tinkerer:


I'm off to do my last minute cramming. I've been pulling all-nighters all week -- don't see any reason to stop now. My last final is in Physiology, over the GI unit. Some fun facts:

• We produce 1-2 liters of saliva a day
• the stomach is capable of expanding to 30x it's empty volume
• the cells of the stomach lining are replaced every 3 days

And one of my favorite terms all quarter -- one of the procedures in diagnosing GERD (gastroesophageal reflux disorder) is abbreviated as a EGD -- I doubt many internists use the full name -- esophagogastroduodenoscopy!

How my head feels at the moment:

(Got Me) Under Pressure

Another quickie as I'm in the midst of another all-nighter after a few hours of sleep this afternoon. On a positive note, I did rather well on my Laboratory Medicine final this morning. A small triumph considering it's not as many credits as the rest of the classes I have finals in, but a triumph nonetheless.





Studying tonight for my Microbiology final in the morning. Lots of pictures of bacteria, trophozites, etc. to memorize as well as 3 clinical correlate lectures. This unit covered malaria, measles, lyme disease, infectious mono, herpes simplex, chickenpox/shingles, parovirus, variouis bacterial skin infections (acne, impetigo, erysipelas, cellulitis, gangrene, etc) and dermatophytes/cutaneous mycoses aka all of the "tinea" infections -- ringworm, jock itch, athlete's foot, fungal nail infections, and finally the lovely ectoparasitic infestations like scabies and pubic/head lice.

Microbiology and the related conditions are pretty fascinating, although the class tends to make you a bit obsessive-compulsive as you start to think about and eventually become completely preoccupied with all the microscopic bacteria and organisms that you took for granted before. I feel like I could end up like Tom Waits as Renfield in the Bram Stroker's Dracula movie, picking and scratching at imaginary bugs while slowly descending into madness. This should be the intro to any Micro class:

Statitician's Blues

Have to make this post short and sweet, but figured I may as well put something up. It's now past 4 a.m., which is my cutoff threshold for the all-nighter: no point in going to bed anymore as my next final is at 9 a.m.

Had to interject some Todd Snider -- not that I'm doing much number-crunching in PA school, but as I'm knee-deep in the sludge of a nasty finals week, I can relate to the chorus:

Too much to think about
Too much to figure out
Stuck between hope and doubt
It's too much to think about

3 finals down (EKG, Clinical Medicine, Pharmacology)
3 to go (Laboratory Medicine, Microbiology, Physiology)

Current status of my brain:

Splendid Isolation

In case you haven't noticed by now, I'm a huge Warren Zevon fan (my blog title and an earlier post title this week are all from Warren). I have to hole up for the weekend and every night next week to do the finals cram again, so it seemed appropriate. I could also extrapolate the notion to life since PA school too in some regards. I decided to move close to school for my didactic year as I didn't want to deal with traffic and a long commute -- time is one resource you can never get back. As a result, I've been a bit more "cut off" from friends out here -- not that I have spare time anyway, but between living where I do and the massive amounts of time spent with my nose in the books, I think this is the most time I've ever spent by myself. Of course, I'm a loner of sorts by nature, so I tend to fend for myself normally, but it's even more pronounced these days. And it's not necessarily a bad thing -- I am quite capable of entertaining myself and I almost need the separation right now to focus on my studies. It's also harder now that my brother is in Dallas as I don't have any family now in the state, but I made the choice to move out of Michigan years ago and it's one of those things that seems wrong at some times and necessary at others.

I probably won't have much to post until the dust settles after finals. I have a lot of info to squeeze into my noggin and can hopefully organize it all and recall it when needed. Back to the science for me ...



And remember to enjoy every sandwich!

I Fall To Pieces

Well, took my 2nd final this morning feeling pretty confident and ended up falling flat on my face, kinda like this guy, sans yarmulke.



I didn't fail the exam, but as I somewhat predicted, I did blow my A in the class. I was hoping to be a bit more Einstein than Homer Simpson, but them's the breaks sometimes.





Think I'll fire Stuart Smalley as my motivational guru -- my daily affirmations are not working as I clearly am not smart enough. Well, I suppose it also didn't help that I forgot to bring my EKG calipers to the test ...



Nothing to do now but take it like a man, dust myself off, and prepare for some more chagrin next week when I take the final four finals (is that an odd phrase or what?)

On a positive note, had our last Therapeutic Skills lab on Wednesday -- we did skin punch biopsies on the cloven hooves of pig feet and some more suturing. This time we learned the subcuticular suture, where the stitches (dissolvable) & knots are all hidden "beneath" the wound. I have to say I was a little confused about it until I actually sat down and then it made more sense. I am actually looking forward to doing some stitching on actual human flesh now -- any volunteers?

Poor Poor Pitiful Me

Well, I thought I had my Clin Med final licked -- it covered the Renal unit and I walked out thinking I had aced it -- turns out I did worse than I thought. And as this test was all about the kidneys, seeing my score felt a bit like this:





I shouldn't really feel too bad -- I still got a solid B. It just seems to always happen that I do worse on the tests that I think I nailed, and better (usually) on the ones I think were disastrous. Not sure why that happens, but it's definitely been a pattern I've seen again and again since PA school.



No time to cry over spilled milk though -- have my next final -- EKG -- in the morning. I'm hoping to fare a little better on this one.



I need to stay positive going into this one. I need to convince myself that it's just 1 more test among many more that I'll take, and that I've put in the proper study time, so it should be no problem. What's the worst that could happen, right? I blow my A maybe. Life goes on. Of course, being that cool, calm, & collected is easier said than done sometimes for me. Guess it's time for my daily affirmations.

Your Nervous Heart

Today's title comes from an excellent track by my brother-in-name Rhett Miller from the Old 97's, my favorite band to come out of Dallas. And why was I nervous today? This morning I had to give a shirt-and-tie 30 minute oral presentation to my class and 4 of my teachers, as part of my Master's track class. I had a nice 40-slide PowerPoint made up to put up on the massive projection screen (we have a large auditorium-style classroom, with theater-seating for about 150), so it wasn't like I had to just give a monologue with no props, but it was nerve-wracking nonetheless, as we are expected not only to be captivating but on a graduate educational level. Jerry Seinfeld summed up the fear of public speaking pretty well in this clip:



Jerry also demonstrates the response my presentation received:



Actually, it went just fine -- everyone was pretty attentive, asked questions, and a few told me afterward that they enjoyed the presentation. Of course, I stumbled a time or two -- though not as bad as old Admiral Stockdale:



I will likely have to do another one next quarter, so the practice is good for me.

Last week, in Therapeutic Skills lab, we learned about casting/splinting and even got to practice putting arm and leg plaster of paris casts on each other. Each of us got to apply both of the casts, and got each one put on us. As you might envision, it was a fairly messy lab -- water buckets, wet plaster, tape, ACE wraps, etc. -- but a ton of fun. For some reason I kept thinking about Smykowski.



Well, finals are on me once again -- I have my 1st one -- Clinical Medicine -- in the morning, so time to put on my War Face.

Blue Valentines

Can't think of a better time for one of my favorite Tom Waits tunes. Waits is my all-time favorite songwriter & right up there with Dylan when it comes to expressing a tortured soul lyrically. Tom's wife once famously said that he writes 2 kinds of songs -- Grim Reapers and Grand Weepers. This one is definitely one of his best Grand Weepers. With Tom Waits tunes, I can usually pick out a few killer lines from every song, but this one is genius from start to finish:



In school news, I pulled it together somewhat on my last Physiology exam. It was one of those "ehhh..." performances. If you don't know what I mean by that, then allow Mr. Larry David to demonstrate the proper use of this expression (here is the set-up if you've never seen this episode -- Larry, Ted Danson, and some other celebrities are opening up a restaurant. Ted wants to use his personal chef as the restaurant's head chef, so he brings over Larry and Jeff to sample one of his meals. This was Larry's reaction after the meal -- when later pressed for more details, he responds very matter-of-factly with "a little too saucy", nearly reducing the chef to tears. You have to love the absolute lack of tact that is LD):




And just for completion's sake, here is Larry explaining very casually to the chef why he didn't like the meal:



So, in one respect it was still satisfactory, as I have been struggling recently, but only slightly so, as obviously everyone likes to do their best. Who knows, maybe that was/is my best. Or maybe I have my sights set too high and should lower my bar a little. One more representation -- the half-hearted Al Bundy thumbs up:



I guess it's like the old saying "Nothing worthwhile comes easy." If that's the case, than PA school must be really, really, really worthwhile. And on that note, I need to get back to the books.

Kicked in the Teeth Again

I had to channel some Angus Young riffage after another rough Microbiology test this morning to soothe my shattered soul. For some reason I just can't seem to lick that class -- after getting an A on the 1st test, it's been a struggle to keep my head above water. To borrow a quote from President Barack Obama:



I guess that's been the theme of this quarter -- a series of highs and lows, defeats and victories.

Today it was more like this:



Granted, I have yet to fail a test (well ... this semester at least), but as I've mentioned before, if you're someone who is used to excelling academically, it's a blow and bruise to the ego to be pulling C's or getting below the class average for an exam. I'm know I'm not alone in this and everyone in my class feels the pressure to some degree. I do know that I can at least say I'm putting forth an honest and concerted effort -- if I was blowing this off or doing it half-heartedly, then it might be more understandable to see my grades slipping, but if that were the case, then I don't belong in the program anyways, right?

I bet that those of you following my blog who haven't been to grad school (or even if you have) must sometimes get a kick out of my unabashed drama. I'll be the first to admit that when it comes to throwing a pity party, I can sing the blues and dish out the "woe is me" song-and-dance with the best of them. You know how every circle of friends or family has one person who can always seems to notice the touch of grey in every silver lining? In my crowd, I'm that guy.



Hey, if nothing else, if you're feeling down yourself, then you can come here and listen to my latest rant about how tough of a time I'm having, how my head is going to explode if I have another test, how little sleep I'm getting, how I feel like I just can't get it together for one more day, etc. and then you can assure yourself "at least I'm not as pathetic as this guy -- what a sour grape! Like Mickey Ross once said in his Pyramid of Pain infomercial, "Let my psychosis work for you!"


I know it probably looks ridiculous at times, but much of the reason for starting this blog in the first place was to capture and make a record of the emotions and struggles of taking on such a significant step as PA school. So far it's by far the most challenging obstacle I've faced, and also one of the most rewarding. And at least I have so far accepted my setbacks with as much dignity as I can muster, a certain amount of kicking/screaming/whining, but most importantly, without losing my sense of humor. Once you lose that, then you're really in trouble... life it way too short to spend too much time feeling miserable or sorry for yourself like the tormented Chris Farley below:



As crestfallen as I can be sometimes, I'm also too stupid and stubborn to know when to quit trying. I'm a pessimist by nature, but a closet optimist.

On that note, here are some quotes I like about the whole idea of rolling up the sleeves and toiling away:

“Opportunity follows struggle. It follows effort. It follows hard work. It doesn't come before.” -- Shelby Steele

“I have had to fight like hell and fighting like hell has made me what I am.” -- John Arbuthnot Fisher

The Test for Leprosy

I had to reach into the deepest recesses of my hippocampus to come up with today's title, the 1st song off the 1st album by Christian metal group Tourniquet. I seem to remember reading that one of the band member's father was a physician, which explains some of their bizarre, medically-related song titles such as:

• Somnambulism
• Impending Embolism
• Pathogenic Ocular Dissonance
• Ruminating Virulence
• Spectrophobic Dementia
• Gelatinous Tubercules of Purulent Ossification
• Vitals Fading
• Phantom Limb
• Broken Chromosomes
• Stereotaxic Atrocities

How can you not love a band with song titles like that? At any rate, the title is indeed appropriate as tomorrow morning brings another Microbiology exam, and Mycobacterium Leprae is one of the flavors in the smorgasbord of diseases covered in our latest section.

We also had a huge section on TB, and other diseases spread by respiratory droplets. I was hoping to find a clip of the classic scene from Michael Crichton-penned flick Oubreak where a movie theater patron sneezes and you are treated to a slow-mo clip of the sputum disseminating throughout the room, landing in the popcorn buckets and gaping mouths of unsuspecting patrons. Alas, I could not find that particular scene, so instead, here are some stop-motion photos of actual sneezes, which should make you flee in abject horror the next time someone engages in an involuntary personal expulsion of nasopharyngeal mucosa in your immediate vacinity.















I also found this pretty fascinating & scary -- a diagram showing how the 2003 SARS outbreak supposedly spread so rapidly:




(if this is too small to read the print, click on it to enlarge)

This post was conceived as a result of having all sorts of bacteria, fungi, protozoa, and other sorts of nasty germs on my mind as a result of studying for Microbiology. I'll try to make the next post less ... unsettling. Until then, I'll be locked up in my apartment, munching on some popcorn and awaiting the next great pandemic, which as one of my professors reminded us, we are sorely overdue for. In the words of a fellow Arizonan:

Some say the end is near.
Some say we'll see armageddon soon.
I certainly hope we will.
I sure could use a vacation from this

I Want a New Drug

I thought I'd be taking it on the chin again on my latest Pharm test this morning

However, this time around I secluded myself for the weekend (who am I kidding? All I do is study these days), forsaking the SuperBowl (well, the 1st half anyways) and immersed myself in the world of Autonomic Nervous System drugs. The section on Diabetic agents and Anticoagulants was fairly straightforward, but the ANS material was fairly complex and voluminous -- not only knowing what the effects were, we had to know if it was a full or partial agonist, which receptors it worked on, whether it was direct or indirect, selective or nonselective, side effects, indications/contraindications, etc. I won't bore you all with any more of the details; needless to say, I was fairly nervous about the test but the studying paid off as I surprised even myself by how well I did.




What else have we been doing in school lately? Well, we started a 2 week suture lab that has been a blast so far. We are working on fake skin that looks quite similar to this:



So for we've just done the simple interrupted and uninterrupted stitches. This week we'll be working on the horizontal/vertical mattress stitches for deeper type of lacerations. And then we'll be doing skin punch biopsies on pig's feet. I'm having a lot of fun with this and they sent us home with a knot board to practice our square knots. I kind of feel like I'm working on the Navy docks with all the knots I've been tying.



In Microbiology, we've moved on from leprosy to sexually transmitted organisms (always nice to see some of those manifestations in full detail on the jumbo projection screen right before lunch!) In Clin Med, we're about to have a test over the pulmonary unit: Asthma, TB, lung cancer, interstitial lung disease, etc. In Physiology, we finished with the endocrine unit and are moving on to reproductive and finally the GI unit. In Pharmacology, we're starting diuretics. In Clin Lab Med, we covered fluid and volume balance today, going over the standard IV compositions for replacing fluid and electrolytes. I'm starting to put together my Power Point presentation together for my Master's Class. Other than that, not much else new to report on. As you can imagine, I've kept busy.

I'll leave you with my favorite anti-methamphetamine ad (a sympathomimetic drug that we covered in our last Pharmacology unit on adrenergic/cholinergic drugs and the ruin of many a life)