Wednesday, February 27, 2013

The MCAT: My Ticket

Exactly three months from tomorrow, on May 23, I take the MCAT. It's the equivalent of D-Day, a potential turning point in my long pre-med journey. Hopefully a positive turning point, with a "victory" (a good score). Given that I want to do an MD/PhD, a victory for me means scoring at least a 35, out of a possible 45. That might not sound difficult, but the national average in 2011 was about a 28. Most people are happy if they get a 30. So naturally, I've been a bit nervous about the whole thing.

But about two weeks ago, I had an epiphany. I realized that I could look at the MCAT in one of two ways: either as standing in the way of my getting into medical school, or as my ticket to getting into medical school. Regardless of which way I view this exam, I need to study my butt off. But having a more positive outlook, I think, will help me be more confident. And confidence, when it comes to standardized test taking (or to anything for that matter), can make a huge difference. Self-doubt, on the other hand, is most certainly not a recipe for success.

Being a musical person, as I pondered the word "ticket," a song popped into my head: The Beatles' "Ticket To Ride." Granted, the majority of the song's lyrics have nothing to do with my situation (thank goodness). But one memorable chorus line definitely does:

She's got a ticket to ride
But she don't care

The MCAT is my ticket. And I don't care what else is going on, what distractions may come my way. I will focus on my ticket. Because one way or another, I am going to ride.

Saturday, February 16, 2013

Health Care: A Risky Business

There are, clearly, risks associated with becoming any health care practitioner, including a physician. One potential risk that comes to mind is an accidental needle stick. This can transmit bloodborne pathogens such as HIV or hepatitis. Obviously not good. Thankfully, I have never experienced that. However, this weekend I did experience the dangers of the health care profession firsthand.
A classic scabies rash.

I likely have scabies.

My mom is a hospice nurse, and one of her patients was recently diagnosed with this skin condition, which causes extreme itching and skin lesions. I have been itchy the last couple of days but attributed it to the cold Chicago winters and dry skin. But this morning, I was literally scratching head to toe - not normal. My mom put two and two together (and she has a couple of the classic scabies lesions on her arm) so we both went to urgent care. The physician there said she couldn't make a definitive diagnosis, but she said we needed to be treated regardless. This involves literally putting a cream on your entire body, leaving it for 8 to 14 hours, and then washing it off. Like with a lice infestation, you also have to wash all your sheets, clothing, etc. A big hassle.
An image of the mite the burrows
into your skin (and lays eggs
there), causing scabies

My mom was at first so embarrassed and upset. But I just laughed. What else could we do? It happened, there was nothing to do about it now. It was nobody's fault. It's an adventure, a learning experience. And I will definitely now know the signs of scabies should I ever treat someone with it!

When you go into health care, you have to be prepared for such risks. It's easy to say you are. But less easy to deal with the consequences if it actually happens. I'm very glad this wasn't a serious issue, and it's one that is relatively easy to treat. At the same time, my reaction to it makes me aware that I seem prepared for health care-associated risks, not daunted by them. That is a good sign, I think.

New [Mouse] Surgeon on the Block

Until a couple of weeks ago, I had mainly been doing genotyping at my lab job. I've got it down to a "science" (pun intended). I've been getting great results, which is wonderful. But I was itching to learn some new techniques. Well, I've gotten my wish.

My supervisor is teaching me animal surgeries. She has dozens of these to perform in the coming weeks and months, and wants someone to help reduce her load. And of course, I'm thrilled to learn something so practical for my future career as a physician-scientist, especially given that the mouse is the most frequently used animal model for diabetes research, which is what I want to do.

The first technique I learned (and am now pretty good at) is called an ELW (Excess Lung Water) procedure. It involves nebulizing mice with LPS, which basically gives the mice a septic lung infection, and then measuring various aspects of their lungs and blood. The most difficult part is taking a blood sample from the inferior vena cava, which you can imagine is pretty tiny in a mouse. And given that I've never really handled a syringe before, getting that needle in and then pulling the plunger back (with the same hand) was at first a challenge. But Thursday I performed my first ELWs on experimental, as opposed to practice, mice, and all went relatively well. (Except for one thing, which I will talk about in another post.)

The other procedure I'm learning is much tricker, and I've only mastered the first half. The purpose of it is to clear the mouse's lungs of blood so they can be used for other experiments, such as histology, sectioning, etc. Cutting out the lungs is the easy part. The more difficult parts are putting the mouse on a ventilator (yep) and catheterizing the heart. Getting the mouse ventilated involves cutting part way through the trachea (again, quite small in a mouse), inserting a trach tube, and then hooking that up to a ventilator machine. The hard part is all the manipulations you have to do with your forceps prior to getting the trach tube in - for example, getting the 90-degree forceps under the trachea without causing the mouse to go into tracheal spasms (so you can pull through silk thread to eventually secure the trach tube). At first, I really struggled with getting that trach tube in. But I am quite good at it now, which is very exciting progress for me. 

After getting the mouse on the ventilator, I heparinize the mouse to prevent blood clots, again through the IVC. Not that bad, considering I now am pretty decent with the ELWs. Another challenge after heparinization is catheterizing the heart. A mouse's heart is literally the size of my pinky fingernail (and I have small hands). You have to get silk thread under the pulmonary artery, cut off half of the atrium, cut the aorta/IVC, and then slice slightly into the left ventricle to insert a small catheter. You then feed the catheter up the heart, into the pulmonary artery, so the fluid (PBS) going through the catheter will clear the lungs. This part of the procedure I am not so good with yet, but I am making progress. "Paso a paso," one step at a time.

It's slightly amusing to me that I am doing these procedures, and really enjoying learning them, given my past history with animal dissections. When I was a kid in homeschool, my mom would go to the butcher and get meat remnants (eyeballs, a pig head, various organs) for us to dissect. My sister would totally go to town with them, using a surgical kit that my dad, a physician, lent us. I wasn't afraid of the dissections, but neither was I interested in them, so I hung back, watching. Now I'm totally into it, and thrilled to be expanding my skill set, as well as becoming more useful in the lab.