Week 10 of 10

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

So, the first core of medical school is anatomy, and it lasts 10 weeks. This was week 10.

We finished dissecting the lower limb and spent the rest of the week studying. It was actually an interesting week outside all the studying. On Tuesday we had the first meeting of the 'Medical Humanities group', which was only attended by about 8 people. We read and discussed passages from Walt Whitman's "I Sing the Body Electric", which actually had relevance to our anatomy experience and the field of medicine in general. Whitman was a nurse during the Civil War, and probably had to detach himself somewhat in order to do his job, much like we focus on learning anatomy to forget about the fact that the cadaver we are dissecting was a person with a family and a job and hobbies and emotions and worries and strengths and weaknesses of character and all those other things that make us human. Good poem, though, if you ever have a chance to google it. The lady presenting the poem talked about the book Body of Work by Christine Montross, which I read over the summer and have been meaning to dedicate an entire blog to at some point. If anyone really wants to know what the first year of med school is like (or at least anatomy), I think her book is right on point and a good read for anyone.

Also on Tuesday, my mother's significant other had an aneurysm in his brain operated on, so she's been staying at the hospital, and I've been staying at her house with Harry. Sadly, Harry, who never used to leave my side when he lived with me and followed me everywhere, doesn't even like me that much anymore. He's also gained about 20 pounds in the two months he's been living here, not surprising given my mother's track record of fattening up her pets.

I also signed up for the student senate elections this week, so I'll spend the next two weeks campaigning and hopefully get elected. I also went to an informational meeting for this honors program called EMET on Wednesday, so hopefully between those two things I'll be able to keep busy outside of class.

My grandpa moved from Fremont to Bellevue and is living at the new Eastern Nebraska Veterans Home, and I went to visit him yesterday. Here he is looking out the window, which I am convinced he does whenever I'm not there, because that's what he's doing every time I arrive.

Here's a picture of the two of us. We pretty much just walk laps whenever I'm there, and I ask him lots of questions, and he gives me mostly one or two word responses. The weather was phenomenal yesterday, though, so we took a walk outside.

I took Harry home with me yesterday, and we ran into my other grandpa, who lives next door but still only sees me every few weeks. I thought long and hard about this last night, because there are people a lot younger than me that never have the opportunity to see both grandpas in the same day, much less on a normal Saturday afternoon without it being a holiday or special occasion. Grandpa had his tree groomed over the summer, and now it is turning the most beautiful colors, so he wanted me to take a picture of it. That's him in the foreground, and those bland yellow trees in the background are the ones in my front yard.

So, that's how I celebrated the end of anatomy. Visited with both grandpas, went to dinner with Joanna, and watched some football from the comfort of my mother's couch. Unfortunately, the College of Medicine didn't give us much time to revel in our accomplishments, as they handed out the note packets for core 2 on the way in the door for the last exam of core 1. I'm going to try to relax a bit today, but at some point I'll end up in the library studying for the clinical exam coming up this next Saturday and previewing for tomorrow's first lecture of Core 2: Cellular Processes.

Pelvis and Lower Limb

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

So, another test in the books, and another week of new dissections before we get our grades back. The written portion of the exam was not very difficult at all, but the lab practical had a lot of tricky pins. My goal, like for the head and neck exam, was to get all the easy points (PBL, living anatomy, radiology, cross sections, and embryology), and I think I was relatively successful in doing so. I'll find out on Friday, as usual, but for now, we're moving on to the fourth and final unit, Pelvis and Lower Limb.

Interestingly, because of the way we develop (as a species that is), part of the male reproductive system was covered in the abdomen unit (namely the testis and associated structures). So, the first two days of this unit had us looking at the entire female reproductive system and what was left of the male (essentially the penis). The area dissected is actually called the perineum, which, if you don't know, is quite an intimate area (I won't describe its borders here, you'll have to look it up). In Body of Work, a book I read over the summer about the author's experience dissecting a cadaver as an M1, she talks about the difficulty she had running the scalpel over such structures as the fingers, and lips, and other uniquely individual structures. She grapples especially with the idea of making the midline incision in the perineum, a cut that would include the clitoris and labia and, in general, skin that is seen and touched in only the most intimate of circumstances. We were spared that dilemma, however, not only by drawing a male cadaver, but also by the fact that the perineum was given as a 'DEMO' (The demo's are basically dissections that are either too difficult or too time-consuming for us students to do, so the instructors dissect, in this case, a male and a female perineal area, and give us about a 30-45 minute demonstration of all the structures revealed). The perineum was similar to the thorax and abdomen in that there are small, hard to distinguish structures all in close proximity to one another, making their identification difficult. Today's dissection, on the other hand, was much more similar to the upper limb, if not easier. We started on the anterior and medial thigh, an area with big, fat, long blood vessels and nerves, huge, easily-separable muscles, and, most importantly, enough room for all four of us to dissect at the same time, which hasn't happened for about six weeks now. So, lab is going good, and we are down to five dissections remaining, so it's really sinking in this week that we'll be out of there soon.

Meanwhile, this week is complicated by the fact that we have our ICE midterm on Friday, so a lot of anatomy study time is being redirected to that right now. Some of my classmates are worried about ICE, but all the M2's I've talked to say they didn't study for it until two or three days prior and it wound up being their highest grade for the semester. In general, I feel very comfortable with my ability to keep up with the curriculum, and I have pretty much stopped worrying about grades.

Joanna is pretty much working from 8AM to 9 or 10PM every day except Sunday, when she 'only' has to work noon to 8, and we both can't wait for election day to come and go. On the other hand, I've been calling the hours I spend walking precincts and delivering signs with Joanna 'extracurricular activities', which they are, and I've put in quite a few hours, and once the election is over I'll actually have to get more involved here on campus. I don't mind that, except most activities and organizations here cost money to join, and, in the words of Sir Mix-a-Lot, "I ain't down with that."

I had my fourth of five preceptor visits to Dr. Roy Monday, and she said she thinks I'm learning a lot. I had a real nice interview with one of her adolescent patients, saw some more ears and noses and throats, gave some flu vaccines, and felt very comfortable overall. I don't go back now until December 16, so I am going to try to fill up some of my free afternoons with shadowing in the ortho clinic and elsewhere. I did a little test on this website called Careers in Medicine over the weekend, and, based on my responses to like 90 questions, they matched me to 'general surgery', so that's another department I may contact this week to try to set up some shadowing.

Anyways, that's enough. I'll put some pictures up next time. This blog is probably getting boring.

Unit Three Sucks

My name is Derrick Antoniak, and this is my blog about being a first year medical student.

So Saturday is the big 'thorax and abdomen' test, and, if today's mini-case session was any indication, I have a ways to go. The anatomy seems easier than the head and neck, but for some reason I feel less confident (could have something to do with the fact that I've had exactly 1 dedicated, efficient study session in the entire three weeks). If that's not bad enough, I had to spend almost two hours in Dr. Carver's office yesterday (student counseling) because my backgroung check looks like that of an alcoholic (at least enough so that entering the medical profession will require me to prove that I'm not). We had a really nice conversation, and he said he wasn't too worried about me, but in the end, I had to take a questionnaire, and, pending the results, I may end up in a more formal alcohol dependency assessment or even outpatient treatment (to the tune of several hundred dollars I'm sure). This is a pre-emptive move on my part (at the suggestion of Dr. Hill). I know without question that I am not an alcoholic, and it's been almost 5 and 8 1/2 years since my two run-ins with the law, but when I graduate, if I haven't done anything to prove it, any residency program I enter would probably send me to rehab just based on my backgroung check and family history, so, I guess it's better to get it out of the way now, while I'm really not that busy (at least that's the theory). It is frustrating, though, and, honestly, a little discouraging, especially when you see how some of my classmates act, not only on days like this Saturday after the exam, but also on just any night of the week. Oh well. So, as I make my daunting transition from a one-beer-every-three-weeks guy to a no-drinks-ever guy...

We have the exam Saturday, and, although anatomy is winding down, we have exams much more frequently overall in the near future. This weekend is exam 3, next weekend is ICE midterm, the following weekend is the last anatomy exam, the following weekend is the OSCE (objective structured clinical exam), one weekend off, then the first exam for cellular processes, which is the next class after anatomy. In reality, I don't care. I think it's going to be downhill after anatomy, and, besides that, I've had some success setting up shadowing experiences in departments of interest, and I think that will be my focus, with the hope that I will meet enough people and get enough experience to really decide what specialty I want to be in and pursue it regardless of competitiveness.

The student should be able to:

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

At the beginning of the semester, we all received a huge package of nicely three-hole-punched handouts for lecture, lab, and embryology, intended to save us the hassle and money of printing it ourselves (it's literally two three inch binders worth for the first 10 weeks alone). The lectures are each one hour long, so the handouts for a typical single lecture include about six pages of notes, the end of which will say, "The student should be able to:" followed by a list of anywhere from 8 to 12 ridiculously complex learning objectives, each of which has entire textbooks dedicated solely to that subject. Keeping in mind that we have several lectures a day, I thought that was humerous (maybe you had to be there).

Anyways, we were given a surgical demonstration today by a 'surgical oncologist' named Dr. Are. Oncology, if anyone is actually reading this, is a field of medicine dedicated to cancer, so Dr. Are's field is a surgical sub-specialty dealing with the surgical removal of tumors. For the past few years, they have been trying to give students in the first two years exposure to more and more clinical aspects of medicine, and the surgery demonstrations in the anatomy lab are part of that effort. They demonstrated the exact same operation for last year's class, but apparently today was the first chance they had to demonstrate on a so-called 'lightly-embalmed' cadaver. A few interesting notes on the operation: 1) The light embalming process keeps the cadaver feeling much more human, which was an interesting twist on the dissection process. 2) Dr. Are was pointing out landmarks to look for, talking about how they go about finding things, and making sure they don't injure things they don't want to, etc., and it became immensely obvious how important the work we do in the lab really is. The dissection we did today involved two hours of digging through the abdomen in search of maybe 6 or 7 arteries, which could have seemed like a trivial task, until we watched a practicing surgeon open the abdomen and point out each of those arteries in succession (among others), and talk about how important it is to get this one out of the way before you start cutting, and using that one as a landmark for finding this other structure, etc. It was a really nice re-inforcement of what we're doing in there this semester. 3) The operation demonstrated is called the Whipple procedure for resection of pancreatic cancer. When someone is diagnosed with pancreatic cancer, you have to say to them, there is about a five percent chance you'll live five years. But if that person is lucky enough to live close to (or somehow have access to) a place like UNMC, or Johns Hopkins, or one of several other places around the world that does a lot of these kinds of things, that number goes up anywhere from 15-30%. So, for my part, I thought the demo was real fun to watch and a good learning experience.

The other interesting thing is how often cancer comes up this semester. It seems like in all three units so far, we get cancer over and over. I think it has to do with the way they are trying to teach us anatomy. One of the big keys to clinical anatomy is knowing relationships, not just knowing where a structure is, but what lies anterior, posterior, inferior, superior, lateral, medial, what is the blood supply, what is the nerve supply, etc. So cancer really fits into that learning system pretty well. Cancer and trauma. Test questions are always like, "A man gets stabbed with an ice pick in this really specific location", or "A woman with a tumor in this area of wherever", and then ask some question about their deficits, and we have to know all the structures, muscles, arteries, nerves in that area to be able to answer the question. So with cancer and trauma they seem to be able to ask us like 15 questions in one, and, if I had to put my finger on the biggest difference between undergrad anatomy and anatomy here, that would be it.

In other news, I'm going Monday to shadow a surgeon in the sports medicine clinic, and I am pumped. I don't know what I want to specialize in, but if I had to pick today, based on my interests and background, orthopaedic sports medicine would be it, so we'll see over the next couple of months if that's something I really want to pursue. They said once I come into the clinic and see some patients, if there is an operation they schedule that I find interesting, I can say, "I'd like to be there and see that operation". So we'll see.

I Stuck a Needle in Someone Today

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

So, I'm going to keep these short to try to avoid the long delay between posts, because this really is supposed to be a journal I can look back on, and a lot of the day-to-day from head and neck got lost because I went so long without posting.

Today I had my second preceptor visit in as many weeks. Dr. Roy genuinely (at least seems like she) likes me and wants me to get the most out of her clinic. But today was a test of her patience. I'm not a guy that likes to use phrases like 'emotional rollercoaster', but we certainly had some high and low moments this afternoon. I don't know how, but after the first two or three appointments, the waiting room was full. And she doesn't run her clinic like the hospital, where a nurse brings you back, then a med student comes and talks to you, then you see the doctor for five minutes. She does it all. She calls the kids back, and (with my help) gets the history, performs the physical exam and any other testing, makes the diagnosis, discusses the plan with the parents, writes the prescriptions, and sets up any follow-up. So all of a sudden, we had the entire afternoon's patient roster sitting in the waiting room and it was just the two of us.

Anyways, besides that, I thought I was getting good at looking at the eardrums, but I totally blew that. I looked, saw the membrane, looked at the other side, saw the membrane, told Dr. Roy that it looked normal, which it ultimately did. But when she came behind me to look, she said, "You see the tubes?" "No." "Look here." So, fully expecting to see some microscopic color change or something, I was stunned when I instead saw these massive, blue intertube-looking rings that wound up being in both ears. I was pissed off, to be honest.

But, I kept practicing. We were in a huge hurry, but I kept insisting on looking in each and every ear, and she kept letting me, and she kept teaching me, at all times, discussing the problems in lay terms to mom and in (slightly) more medical terms to me. And, by the end I was feeling a little better. The last appointment was a guy with his three sons all in need of flu shots. I've seen Dr. Roy give plenty, but so far she had only let me give the nasal mist flu vaccine. But today I was promoted from the guy holding the legs down (kids don't like shots, it's by far the worst part of pediatrics so far) to the guy giving the injection. When I finished, Dr. Roy said, "different than chicken, right?", knowing that's what I had practiced on at school, but honestly, other than the insanely loud screaming and crying, the injection felt remarkably similar.

And the score at halftime, Derrick 2, Med School 0

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

On Monday morning Dr. Binhammer came into the lab and said something to the effect of, "Welcome to the second half of gross anatomy. I know some of you are behind by a couple of touchdowns, but we have time to make a comeback." So today is Friday, which means we finally know just what that score is. Like after the first exam, I'll just say that I did fine. I won't break down the numbers, but I had almost the exact same percentage score with a slightly lower percentile ranking. So, moving on...

Last night was Kylee's birthday party at the Upstream and then the Crescent Moon, which means that five days into the thorax and abdomen unit, I still have barely done any studying. I didn't feel as bad, though, after we got to the Moon and about 10 of our classmates were already there getting hammered and talking about going back to some frat house to shoot some whiskey. I do have a lot of catching up to do this weekend. Today I took Joanna out to lunch and, despite my best intentions of coming back to the library for the balance of the evening, I wound up going home and taking like a three hour nap. So now it's 6:30, and instead of leaving campus having studied for the past 5 hours, I'm just getting here. And if I'm not far enough behind, I've now spent the last ten minutes writing this.

Anyways, I sent out a couple of emails yesterday trying to shadow this neurologist Dr. Singh, and this orthopedic surgeon Dr. Garvin, both of whom emailed me back and said to set it up with their secretaries and they'd be happy to have me. That's been one of the most impressive things about my med school experience so far. I have contacted faculty members at this medical center in departments all over campus, asking to shadow or participate in research, or whatever reason, and not once has it taken more than a day to respond. And the response is always an enthusiastic "of course I'll help you in any way I can, just call or stop by". And you look at the list of things these people are doing and wonder how they can even check their email that often, let alone send a response or take a student under their wing. So I find that impressive and encouraging.

Yesterday we got to look into each other's eyes with the fundoscope. It's not the easiest thing in the world to do, and it will take much more practice than we were able to get yesterday. But basically, the back of your eye has some interesting things to see that can be useful in diagnosing problems totally unrelated to the eye itself. It's the only place in the body that you can look directly at and actually see the small blood vessels, so often you will have a fundoscopic exam as part of a diabetes diagnosis, for example. The problem is you have to look through the pupil using this magnifying glass/flashlight tool, and, if you know anything about the pupil, it constricts when you point a flashlight at it. So it ends up being like looking through the old-school keyhole, where you can see a tiny window, and if you move your head up, down, left, right, you can move the window around to see different parts of the entire scene back there. The other problem is that the instructor can't exactly see what you are looking at. So, I think I was able to trace the blood vessels backwards and see the optic disc (landmark we were told to look for), but in reality, I'm not sure, and the TA has no way of confirming or denying it for me (he also has no way of denying it if on the exam I say that I see it, but that won't help me much out in the real world).

Thorax and Abdomen I

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

So we're back at it again, and, like after the first exam, we get to work our tails off for a good solid week before finding out our grades from last Saturday. The new unit: thorax and abdomen. Most people don't know what the thorax is, but it's really just the region of the body containing the lungs and heart (and their neighbors, such as ribs, esophagus, etc.). As usual, we wasted no time getting in there. With an autopsy saw, we removed the chest wall, exposing the lungs, which turned out to be the best in the lab. By best, of course, I mean in the worst condition. There is a disease most people have heard of called emphysema, characterized by enlarged air sacs on the lungs. Bootstrap's lungs were covered with golf-ball-sized air sacs that had Binhammer sending the whole lab over for a look.

The next logical step after you remove a man's lungs is to expose and remove his heart. Being logical people, we did just that. So far this semester I've been sort of a dissection hog, which no one really minded when it came to things like cutting down the middle of the face and chiseling through the top of the skull to get to the eyeball. But as it turns out, Kylee's favorite organ is the heart, and because she wanted to so badly, and because it's her birthday tomorrow, Tony and I of course had no problem letting her be the one to single-handedly remove the heart from the body. We spent most of yesterday and today looking at structures on the surface of the heart, and then cut it open today to look at structures inside. So far, we all feel lost, which has been the case for the first few days of both previous units.

Meanwhile, I'm thinking of applying for this thing called an Enhanced Medical Education Track (EMET). It's a new program where students can do things above and beyond the curriculum and get that recognition at graduation. I am looking at the auto-immune disorders track, and I am relatively certain I will apply for it. It requires about 440 hours in the first year, and about 160 in the second, but a lot of the time spent will be doing things that I plan on doing anyways. There is an opportunity for summer research, which I would have applied for anyways, shadowing, which I would have done anyways, and the research you do can be used for an honors thesis in the fourth year, which I would have tried to do anyways. It's competitive, as they will only take three students, but I met with Dr. Thiele today, and think I've decided to pursue it.

Anyways, Joanna's mom's birthday is today, so I need to get to studying so I can go have some cake and ice cream.

Reflections on Head and Neck

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

I feel like so many interesting things have happened since my last post, so I will list as many as possible and do none of them justice.

So our dissecting group really has become pretty close. We sit for hours at a time picking fat and connective tissue from a cadaver we call Bootstrap, and I guess that experience, along with the solidarity that comes from going through a difficult life experience together has really put us in what Seinfeld referred to as the 'relationship time machine'. In the five weeks we've known each other, we've shared some good healthy laughs, some dry heaves, occasional tears, and covered the entire spectrum from the lightest to the heaviest moments. About two weeks ago Kylee told Tony and I that she was glad we were a group. The silence that followed prompted some laughter and teasing, but, in reality, I know that we get along well and genuinely care for each other, and I enjoy coming to lab to work with them every day.

Meanwhile, back in the real world, we had an exam coming up. The timeline went as follows: Luke and Janel's wedding was the Saturday before, and it was a blast. It's strange to be a full-blown adult, but I have some great friends that I know will be a part of my life forever, and for the short time I was at the wedding, we rocked it out pretty good. The next morning I got up and ran the corporate cup 10K with Joanna (and by with I mean far, far behind), had lunch at Amarillo, and then went to the gross lab to meet with Kylee and Tony for a review session that was too annoying to finish with my lost voice from the wedding. By Monday, my lost voice had turned into a cold, and its timing could not have been better with the exam looming. I finished the week out strong, though, opting to study most of Friday evening instead of attending the debate-watching party at Joanna's work. I woke up early on Saturday, ready to dominate. Unfortunately, Binhammer and company had different plans for me in the form of an essay question that completely caught me off guard and most likely reduced my exam score significantly. I left the lecture hall knowing that I had passed the exam, but knowing that I hadn't done as well as I wanted to.

As I was walking to my car, though, I was thinking about all the times I had heard the term 'head and neck', not only these past three weeks, but also the dreadful anticipation of 'head and neck' during orientation and the first two weeks of class, and also from the M1's and M2's I had talked to in my interviews both in 2007 and 2006. Dr. Binhammer told us of the many people around campus that say if you can pass 'head and neck', you've got your MD. I can even remember as early as 2005 my biochem professor at UNO telling me about this rite of passage in med school called head and neck.

So I left there not wanting to let that moment pass me by lightly. I had completed the unit, taken the exam, and in all likelihood passed it, and I had sort of the same feeling that I described after the white-coat ceremony, like 'I'm here, I'm really doing this thing that I looked forward to for so long'. So to celebrate, Joanna and I walked door-to-door handing out republican party voter information (slightly less intense than the liter-chugging-contest my classmates opted for at the Crescent Moon, but as anyone who heard Michelle's 'Heads Carolina, Tails California' speech would appreciate, I just wanted to be with her wherever we were).

Test 1 Grades and LCE Day 1

My name is Derrick Antoniak, and this is my blog about being a medical student.



The College of Medicine decided that we would get our exams back on Fridays, so there was a predictable rush to the mailboxes (tests are returned via campus mail, and all 132 of us have mailboxes in about a 15 foot space on the wall of boxes) Friday morning, and I could not help but take part. Long story short, I did fine. Anatomy is one of five 'cores' that we have to take this year, and that exam was one of four that we have to take for this core. So there are a lot of other pieces to pay attention to.



One of those other pieces is called the 'longitudinal clinical experience' (LCE), in which we are assigned a preceptor in whose clinic we work five times per semester for a pass/fail grade that is factored into the Integrated Clinical Experience core. Today was my first day of LCE, and I was far more excited for today than I was for the first anatomy exam.



My preceptor, who I'll call Dr. R, runs a tiny pediatric clinic in South Omaha. She is a very nice, very short, sort of middle-eastern looking woman of about 40(?) years of age. I arrived a solid ten to fifteen minutes early, wearing my shirt and tie, white coat, UNMC name badge, stethoscope around my neck, and some other tools in my pocket (tendon hammer, tuning fork, physical exam handbook, etc.). In about 2 and a half hours we saw three kids, two of whom were brother and sister sharing the same bacteria.



I sat down on the little stool with the wheels like any good doctor would, pulled my pen out of the breast pocket of my white coat, clicked it once, and started the interview: "So what brings you in today?" Unfortunately, this is a small clinic. Dr. R has seen this woman and both her kids about once a month (at least) for the course of their little lives, prompting the 'my kids are sick, you idiot' look from the mother. More questions: How long has he been sick? Oh, discharge from the nose? How long for that? Any cough? Sore throat? Fever? Any other symptoms? Then on to the exam, and at this point I am just following Dr. R, who is trying to show me the tympanic membrane (eardrum) through the otoscope, but all I can see is hair and earwax. Kids don't stay still for long, so we're trying to hold his head, and finally she's pointing out the 'cone of light' that indicates a normal eardrum, and I can see it, but I doubt that I could have found it myself. The process is complicated by the fact that we just learned some ear anatomy, and two different professors mentioned that kids have short auditory canals, so you have to be careful not to stick an otoscope through their eardrum (no pressure).



What's scary about all this is how essential it is. Middle ear infections (the type you can diagnose by looking at the tympanic membrane through an otoscope) must be actively treated because with the middle ear's proximity to the brain, they can lead to meningitis. So it is absolutely necessary that I learn this skill. On the bright side, to get from where I am today to Dr. Roy's position (licensed pediatrician working with no supervision) will take seven years, and I think I should have it by then.



So we had two kids with upper respiratory infections (URI), and we prescribed them both a cheap antibiotic and one of them some extra asthma medicine (some type of corticosteroid, I don't know the names). I went back to my desk, looked in the pediatric handbook, looked in the massive textbook of pediatrics, looked at a few point-of-care resources on UNMC's intranet, and all sources said that URI's are mainly viral and resolve themselves. Stumped, I asked Dr. R why antibiotics had been prescribed, only to find out that I had apparently missed something. The drainage from the nose was very thick, indicating probable bacterial involvement, and amoxicillin is cheap, and usually an effective first-line antibiotic.

So, not the smoothest first day, but I left with an experience to build on and some nice learning objectives to look up before next time. Meanwhile, back to the library and gross lab and hopefully home for at least the second half of the game.

Head and Neck

My name is Derrick Antoniak, and this is my blog about the first year of medical school.

Well, we've moved on to unit two, head and neck. It just so happens that yesterday was Joanna's birthday, so I had some people asking me questions about school, and I also talked to my cousin Tom on the phone, and he was asking me how things are going. People really react to the things we are doing in class right now, so I thought I should write about some of them here.

Monday began the face dissection. My group gave me the privelage of making the skin incisions, which involved cutting our man with a scalpel from the center of his forehead at the hairline, down the forehead, down the center of the nose, through the center of both lips, down the center of the chin, all the way to the base of his neck. Then I cut around both eyes, his nose, and down the sides of the head just in front of the ears, and we skinned all but the nose to expose muscles, arteries, veins, and nerves. After lab, the instructors went back in and cut off the top of everyone's skull to expose the brain. Being the over-achievers that we are, Tony (a group member) and I were in the lab later that night and had the good fortune of witnessing this process on a few cadavers. They use a power saw to get most of the way through the bone, but, in order to not damage the brain and its covering, the last layer is broken off with a hammer and chisel. The smell of the bonedust and the sound the skull makes when cracking under the chisel are by far the worst things I have witnessed in the lab yet.

Tuesday we returned for a dissection called 'cranial cavity'. We really spent most of our individual time trying to straighten out the muscles of the face, waiting for the instructor to come remove our brain. The brains have to be used in the spring semester, so rather than let us remove them and risk damaging something vital, the instructors come to each table and systematically remove them, starting in the front and working their way forward, pointing out, and then cutting, each cranial nerve in reverse order. Between the mangled faces, handling the brains and pieces of skull, and the rather large amount of juice left behind in the cranial cavity, it was too much, and for the first time (that I know of) we had people going to the locker room to get sick. Kylee (another of my group members) had a pretty forceful gag (that only by the grace of God did not have any vomit behind it) that sent her to the locker room and sent me and Tony laughing so hard that we both were crying.

Wednesday's dissection was titled 'orbit', and the first line of the lab manual directions had me cutting bone with chisel in order to get into the cavity of the head that holds the eye. There is a 'superior approach', in which I had to cut through the roof of the orbit (part of skull), and expose many of the nerves, arteries, and muscles that make eye movement possible. In the 'anterior approach', Tony had to cut through the eyelids, dissect some of the structures involved with tear production and secretion, and, ultimately, remove the eye itself. Kylee was able to juggle the directions for both of us at the same time, and at the end she wanted to be the one to remove the eye and cut it in half to get the lens out. I am stating everyone's role because I fear that our group of four may become a group of three. Our other member didn't seem (to me) like she was ready to quit, but she has been absent two days in a row, and I know she has a young baby at home. We feel like we didn't even have a chance to try to help her work through it. We'll see.

In other develpments, we still hadn't named our cadaver. Towards the end of lab today, our guy was laying face up, with his head sort of propped up on a piece of wood to facilitate working on his skull. For some reason, with his face in the condition it was in, he looked like the dad from Pirates of the Carribean, (Bootstrap Bill Turner) so we decided to call him Bootstrap (this is not a disrespectful practice; it is an affectionate name for a man to whom we inevitably feel extraordinarily close).

Exam 1 in the Books

My name is Derrick Antoniak, and this is my blog about being a first-year medical student.

Well, yesterday was the first exam of medical school for the 132 members of UNMC's class of 2012. So, to recap the first two weeks:

On day 1, we met our cadavers, then proceeded to dissect the entire back, scapular (shoulderblade) region, pectoral region, axilla (armpit), arm, forearm, hand, and fingers by the end of week 1. The first two weeks also included lectures on fertilization and early development, along with lectures covering each of the body regions dissected in lab. Living anatomy, another significant portion of our learning experience, is an exercise in which all 132 of us take our shirts off in the amphitheatre and palpate (fancy word for feel) muscles, nerves, arteries, bony prominences, etc. in each of the body regions being covered in lab on a previously chosen partner. In addition to all that, we've had some afternoon lectures and small group meetings covering health care quality and professionalism.

The test was scheduled for Saturday morning. Very few people acted real confident that they understood the material and knew they would pass the exam. The levels of stress, though, varied pretty significantly amongst my classmates. Some flat out said they were probably looking at the 'five year plan' (if you fail, you repeat the first year). That's the high end of it, but I assume that the entire spectrum of pre-test anxiety was well represented. For my part, the night before the exam I went to UNO at 5 for the chemistry department's 2008-2009 kickoff (there was free pizza), after which I spent about 3 hours with Joanna delivering Johanns for senate signs to the good little republicans who had requested them. An ill-advised trip to Taco Bell, about another hour of liesurely review, and I fell asleep at Joanna's house around 11.

I woke up at Joanna's the morning of the exam about 5:15. I went home, showered, dressed myself for success, and made my way to school. I was in group A, which meant that I had to report at 8 for the written portion of the exam. Group B reported to the gross lab first for the practical exam. We had 2 hours 15 minutes to complete about 45 or so multiple choice questions, one page front and back of short answer, and two essays. The questions were tricky, but manageable. I finished early, so I had to go wait in the hall outside the gross lab until the switch was to take place. They try to prevent interaction between the two groups between the two portions of the exam, so we sort of get herded around the halls down there in a specific pattern until we finally got inside the lab and positioned at our tables. The way it works, if you've never taken a lab practical, there is a computer hooked up to a sound system in the lab. Every minute the computer sounds a bell. When you hear the bell, you move to the next station, read the question, look for the pin in the cadaver, and try to answer the question before you hear the bell ring again. A little twist: after question 15, the bell rings, you take your shirt off, put down our paper and go sit down in the 'waiting chair'. The bell rings again, and your living anatomy partner (who is mandatorily next to you) takes off her shirt and joins you at the waiting area. The bell rings again and you both go into the first living anatomy cubical and one of you grabs a card: "Demonstrate the bony prominences of the shoulder." Before you finish the bell rings and the other partner grabs a card: "Draw the flexor retinaculum on you partner and its bony attachments. Explain what you are doing." Before you finish, the bell rings (or even worse, you finish first and stand there feeling awkward because you're topless, and the grader feeling awkward because he/she can't let you see how many points you lost or why on the little clipboard) and you move to cubical two. There are a total of four cubicals for living anatomy. After the final bell rings in cubical four, you walk out and put your shirt back on. The bell rings and one of you moves on to station 16. The bell rings again, and the other partner follows suit. There are a total of 55 stations, and, other than the living anatomy, I am relatively certain that I scored very well in the lab. There was not a single cadaver whose pin I could not identify, and there was not a single x-ray in which I could not identify 'the structure at the tip of the green arrow'.

Well, this is getting out of hand, so I'm going to stop. We get our grades back next Thursday, so I'll post mine at that time. Meanwhile, we start dissecting the face tomorrow, so I think it's going to start to get a little tougher for people to cope in the lab, but we'll see.

Reflections on Week 1

My name is Derrick Antoniak, and this is my blog about being a first year medical student.

Well, today is Labor Day, a day that has always been special to me since I've traditionally been a construction worker looking forward to the end of another hot summer of hard work. This holiday weekend, though, has been mostly built around my study schedule. In fact, I've been watching the dog for my mom while she's out of town, and Joanna's been working pretty much day and night between her two jobs, so aside from the Husker game, I haven't done much at all.

With the holiday today, we had a scheduled session in the gross lab Saturday morning, which turned out to be very worthwhile. Many people left town for the weekend, so with the lab less crowded we got more time with the instructor in those two hours than we got on Tuesday through Friday combined. We finished the dissection of the hand, which means that with the exception of a demonstration on joints, we are done dissecting for the first exam, which is this coming Saturday.

I feel good about school right now. I think the pace is good; we're moving quickly, but not too quick for me to keep on top of it. It's nice, of course, not working. We have five mornings (8 to 12) and two afternoons (1 to 3 or 4) scheduled each week, with the rest of the afternoons and weekend unscheduled, so I haven't done the math yet, but I may be putting in about the same amount of total hours that I was between school and work as an undergrad. The stress level is admittedly higher, but so is the motivation and interest.

Today I am actually reading the anatomy textbook for the first time, which brings up another interesting point. We have more tools for anatomy than we can possibly use. There are dozens of atlases, we have a textbook, a more concise review textbook, there are anatomy flash cards, online we have hundreds of images, slides, radiographs, etc., there are power point lectures online, along with hard copy handouts for each lecture, in the lab there are videos showing dissection of each body region that we're working on, boxes of bones, and of course, the cadavers themselves. It's been fun to have some autonomy in deciding which study aids I want to use, and when and how to use them.

Anyways, back to the grind.

Day 4

My name is Derrick Antoniak, and this is my blog about being a medical student.



While many of my classmates are talking about being overwhelmed by the worlkoad we've been given this week already, I am extremely happy to be where I am now. I don't know why, but today, and a little last night, I started thinking about how hard I've worked to get here, and it just didn't matter how hard I've been working these past few days. I am happy. When I set out a few years ago my ultimate goal was to become a physician, which I have not yet achieved. I have, however, gotten over the major stumbling block in most people's road to joining this profession by getting into this school, so it really is, in a sense, downhill from here. Meanwhile, back in the real world:



Yesterday, my dissection technique felt like it was getting better. I was able to expose the subclavian, axillary, and brachial artery and most of its branches without destroying them, which was the theme of day 1 and most of day 2. Today, though, we had to separate the muscles of the arm and anterior forearm, and it was a super slow go. When lab ended we were a little behind on our dissection, and had no time whatsoever to actually learn the names of anything we were exposing. We voted to stay late tomorrow instead of tonight, which works well for me, since Joanna works tomorrow night anyways. I spent a lot of time studying embryology last night, which so far is tougher conceptually than the anatomy (for me at least). And today, I contacted Dr. Roy, a pediatrician in Bellevue with whom I will be spending some afternoons as part of our 'Longitudinal Clinical Experience'. We are going to meet next Thursday to figure out each other's schedules, which is nice, because I will be able to get the first exam out of the way before I actually have to go work in her clinic.



Right now I'm procrastinating, so I'd better get back to work. Today's topic of study: placenta and fetal membranes, and maybe some muscles and nerves of the forearm.

First Impressions

My name is Derrick Antoniak, and this is my blog about starting medical school.

I planned on writing about the latter half of orientation week in detail, until I experienced it, and it wasn't worth writing about. I will mention a couple of things. The so-called 'white coat' ceremony was not at all as glorious as I thought it would be, but something cool happened afterwards. I realized that people actually wanted to be in my shoes that day. There was a group of pre-meds interviewing, and on their tour of the building they passed us in the hall with looks of envy. My cousin's little 4-year-old thought it was cool to play with the toy doctor set my grandma bought as a joke, and he enjoyed it that much more when I donned the white coat and pretended to listen to his heart. So, for a brief moment, I felt as if I had accomplished something.

And then I came back to the real world. In this new real world I may not have much time to write blogs, so the ones I do write will be thrown together in a few minutes like the one you are reading. I'm two days in, and here is my experience so far:

At 8 on Monday we had to report to the gross lab for the back and scapula dissection. After about 30 minutes of introduction to the lab, we uncovered our cadaver and began dissecting. We have a larger male cadaver, so flipping him over, our first ever task of med school, was a disaster. Our group of four could barely do it, and in the process, the cloth meant to cover his face until the actual face dissection just fell off, and we got an unexpected early look at the man who donated his body so we could learn. We dissected for three hours, and when it was time to go to lecture, we had come nowhere close to finishing the day's dissection. Changing out of the scrubs for lecture is complicated by the fact that there are about 80 lockers in the locker room's one aisle, nearly all of which are occupied by students who have the same exact schedule. We literally changed clothes shoulder to shoulder with one another with a line of students extending out the door waiting to get in. Immediately after lecture we went back to the lab, back to the scrubs, dissected for another two hours to finish that day's work. From the time we left lab at 2:30 to the time I went to bed at midnight, I could not get the smell of embalming fluid off my hands no matter how hard or long I scrubbed with every soap dispenser I came across.

The material is not too hard, but there is a lot of it already. It wasn't the hardest day of school I've ever faced, but I have to do it every day, so jumping right into a mid-semester study routine was obviously necessary on day 1. I did manage to get away long enough to attend Lee Terry's forum on energy and go to the gym with Joanna.

I am not stressed about passing. I am stressed because I found out that the top 6 in the class get a Regent's Scholarship, which I believe pays full tuition, and I feel like I'm capable and in need of that, so I'm really going to go for it.

"Make sure you go to the social events"

My name is Derrick Antoniak, and this is my blog about medical school orientation week.

So last Friday the guys at work bought me a steak for lunch and sent me on my way, hopefully never to return to the ranks of construction work. I left work, went to the gym, showered, drove home, and threw my work clothes from that day straight in the trash. Due to the wonders of Facebook, along with an almost overly social group of classmates, I was forced to make the transition from construction worker to med student (i.e. tone down the cusswords) in about two hours so that I could attend the M1 (first year med student) party at the Barleycorn.

That initial party was strange, to say the least. I don't typically go alone to bars where I know absolutely no one. Typically, everyone you pass by at a bar doesn't make eye contact and extend their hand to meet you. And when you meet people, you don't typically exchange a couple of minutes of small talk and then move on to the next shakeable hand. But this was the story of Friday night. I met a lot of nice people, though; I just hoped they would all be wearing nametags next time I saw them.

Back in June we received our Blackboard usernames and passwords so we could do the pre-matriculation program called "Fast Start". Part of this program was an unofficial guide to the first year, written by M2's (2nd year med student, see the pattern?). At least 5 different places in that guide stressed over and over "go to the social events during orientation week", "orientation week is the best week of the year", "my best M1 memory? Definitely orientation week", etc.

So here's the story of orientation week so far:

Day 1: Does this look like a face you can trust?





The first day we gathered in an auditorium. I was one of two people wearing a tie. Several of my eventual small group members were wearing shorts and t-shirts. I told Joanna that they would probably step it up a little the next day, and the other guys wearing slacks (and that other dude with a tie) would probably step it down. I decided that I would still wear the shirt and tie all week as planned. No offense to my classmates, but it's really not about what they think of me. It's about making a good first impression on people who are going to be evaluating me for the next four years and potentially helping me land a residency or job down the road. Nothing notable from orientation that day except how over-the-top everything in our new building is. We have THE best, biggest, and most technologically advanced facilities of any medical school in the country with the opening of the new building this fall (in jest, the dean said that would probably last a couple weeks).


I actually helped install some of this glass.



There are infinite places to study in this place.



I don' think this picture does justice to the size of that screen.


That night was a gathering at the Brazenhead at 8. At 9:40 they had to buy another keg because they had already finished the first four. I felt like I was forcing myself to be there. The few people I've gotten to be friends with, it was nice seeing them in that social setting, but after making an appearance I was ready to go. Most of my classmates are 22 or 23, graduated high school in '03, '04. I have enough to answer for when the background checks come through, so I don't feel the need to get rowdy every night this week and jeopardize all my hard work.

Well, it's noon on Wednesday, and not only is this getting too long, but I have a social event to get to (golf outing at 1). I guess I'll have to write a part 2 at the end of the week.

Closing In

My name is Derrick Antoniak, and this is my blog about trying not to die in a fiery motorcycle crash before fulfilling my four-year-long dream of starting medical school.

So, I have three days of construction work left, and I am just trying not to get hurt at this point. Last week I was sent to help install a huge mirror in a fancy new condo in downtown Omaha. For those of you who have never worked for a glass company for 8 or 9 years, most of the worst stories you hear around the shop table of horrific cuts and blood and guts come from broken mirrors. It's pretty simple: they break sometimes, and when they do, unlike other, safer types of glass, they break into huge, heavy, sharp pieces that you really strive not to be underneath of. So, needless to say, I will be glad when 3:30 comes this Friday, and I can give all my work jeans and boots to the Goodwill.

Things are falling into place now. I have the orientation schedule, a parking permit, one textbook (waiting for financial aid check for the rest), and even a day-by-day schedule for the first semester. Interestingly, we will not even step into the first day of class until August 25, but the first exam is scheduled for Saturday September 6.

Overall, the schedule doesn't look too overwhelming, other than the fact that "Mon. 8/25: Back and Scapular Region" means that on the first day of class, the very first thing that I will do at 8:00 AM will be to cut open a dead human body. I guess if you only looked at the left side of the schedule, where it shows the times we are required to be in lecture and lab, it would look like a real easy semester. But when you look at the right, and realize the amount of information we are supposed to learn in those short two-hour windows, it gets a little scarier. There is also individual lab time to consider. In Christine Montross's Body of Work, the author, a recent med schoool graduate, mentions a key-coded access door to the gross anatomy lab allowing students 24/7 access to their cadaver for study (Brian Fox, upon hearing this news, promptly asked me to take him with me after hours to check things out).

Realistically, though, I am not too worried about the workload. It wears me out, however, thinking about how many new people I have to meet next week. The situation sort of reminds me of how I feel about going to the gym sometimes. I love working out when I'm there, and I never leave without getting a great workout. But when I'm sitting at home, thinking about going, the process of putting together my gym bag, driving out there, hitting the locker room, etc. is too much of a pain.

I don't really mean that though; I am excited to meet my classmates. Although I worry that most of them will be a few years younger than me, and probably none of them will share my financial situation (i.e. trying to buy an island but can't stop accumulating debt). Oh well, the good thing is all I have to worry about is working as hard as I can. And with orientation week ahead, I am starting to feel the hunger that got me to this point.

Two more paychecks

My name is Derrick Antoniak, and this is my blog about almost being a medical student.

I have known for a long time that I would be giving up paid work when med school orientation rolled around, but it has just come to my attention and begun to sink in that I will only be getting two more paychecks from Keystone Glass this year, and that will be the end of my income for the next (at least) nine months. I guess I will have to be the lame-ass mooch on our New-Year's-Eve trip to Colorado, a trip that I am not honestly looking forward to with quite the fervor of some of my fellow ski/board buddies. It's not that I'm not excited; it's going to be an awesome trip in an awesome spot with my ridiculously awesome friends. It's just this pending pesky 21-credit-hour semester that seems to be occupying all my attention.

As I'm sitting here looking at the orientation schedule I just got via email, I'm starting to actually get nervous about being able to handle it all. Interestingly, this is the first time this thought has entered my head. I remember in the fall of 2003 when I was a senior at UNO with 105 credits and nowhere near graduating or knowing anything that would make me valuable as an employee. At that point I was doing the research (and soul searching) that would end up making me decide on medicine, and there was just no doubt in my mind that I could ace every class and become this phenomenal physician. Four years later, I have (so far) done just that. I literally aced everything since starting pre-med classes in the fall of '04, and if I look across the room right now I can see on display bachelor's degrees in both Spanish and medicinal chemistry. And NOW I'm getting nervous? When I had nothing but potential (see quote below) I wasn't nervous, but NOW I am? That can't be right, maybe I'm just dehydrated. It's pretty hot out.

I've hit you off with some pictures from our Wisconsin trip this summer.

"Potential means you ain't done shit yet." -Odious Lee, Bellevue West High School, c.1999

Grandpa Joe

My name is Derrick Antoniak, and this is my blog about being a medical student.

This post is actually totally unrelated to medicine and to school.

I was driving down Cornhusker Road in Papillion earlier today and looking at the rows of identical houses, each with the same roof, same windows, same siding, etc. and I noticed that they all had chimneys. I thought about what the insides of those homes probably look like (with respect to the chimney), and the picture in my head was of my girlfriend's mom's house: a gas fireplace with a fake log and some large, square marble tiles surrounding it for a few feet in all directions. My first thought was involuntary: "When I build a house it will have a real wood fireplace." I didn't know why at first, since the gas ones are much easier to both operate and maintain, and I don't exactly have a massive pile of firewood sitting in the back yard as may have been the case 10 years ago. After thinking about it for a good deal longer than I probably should have, I realized that whenever I think of any aspect of owning and maintaing a home, the image in my head is always of my Grandpa Joe.

I have been fortunate enough to have lived two houses away from my grandparents for as long as I can remember. The house I live in was actually owned by my great-grandpa, and the bedroom in which I sleep was actually my grandpa's bedroom when he was growing up. The neighborhood has naturally filled in since those days, and one of the houses built just two doors down was built by my grandfather during his time as a bricklayer. My earliest memories start at about age 5, at which age I was already living in this house, with my grandparents two doors down and my grandpa's brother Chuck and his family living in the house in between. And whenever I think about winter in Nebraska, I always, at least transiently, think about the beautiful tan-brick fireplace at my grandpa's house.

Grandpa was a bricklayer, and so were his brothers, so all the labor that went into the construction of his house was virtually free. For that reason, if you go into my grandparent's living room, you will see one wall made entirely of brick that would rival any one wall in any home in Omaha. This wall contains the front door, numerous depressions which hold, among other things, a grandfather clock, some pictures, and my grandmother's seasonal decorations, the fireplace itself, an intricate vent above the fireplace, and a large cutout next to the firplace for the storage of a couple days worth of wood. There is also about a seatcushion height ledge that runs the length of the wall that can be used as a shelf for displaying decorations or pictures, or for extra seating as it was used for so many years on Christmas and grandkids' birthdays. It is this fireplace that I think of when I think of someday building a house of my own. I think of my grandpa, out in the blistering cold with his stocking hat, his thick red beard with a few regal strands of gray, and his tan coveralls and overcoat. He would wheel his wheelbarrow down to the disconnected back garage and fill it with firewood once every day or two or three depending on how fast he was going through it. And as soon as he got home from work every day the fire would be lit, and the balance of the evening spent relaxing in close proximity to it. I can honestly say the the only thing that could match the intensity of the cold outside in the Nebraska winter was the warmth inside that house (my cousin Tom may disagree, see below). The labor, tools, and materials used to build the house were those of commercial bricklayers, and the result was a house so well insulated from the outside elements that it was like its own world in there. And with Grandpa making a fire and Grandma making up some stew or bean soup, these images are literally the only reason I even can stand the anticipation of the brutal winter each year.

But in any season, my grandpa was and is the king of taking care of his home. When I think of October, I think of Grandpa out in the back lot raking a ridiculous amount of leaves in his Nebraska sweatshirt with the football game playing on the radio (I actually think he still prefers to listen to rather than watch the games on TV); in the spring there was always some kind of project going on over there; in the summer he would spend literally half the weekend, every weekend taking care of the yard and the pool so we could swim during the week (funny note: he usually would have my mother as an obstacle while vacuuming the pool as she has an insatiable appetite for sunbathing during the summertime).

I feel fortunate to have grown up so close to my grandparents and to still have them just as close now. For me it's hard to imagine Joanna's situation: the last of her grandparents, her grandmother on her mother's side, died in 2004 just before we started dating, and she never really lived in close proximity to any of them, at least not that I've heard about.

As promised, I want to tell a little story about my cousin Tom and his wife Leah, two individuals who probably don't associate with my grandparents' house the intense warmth that I described above. Tom did a year of college at UNL, after which he finished his degree at Iowa Western. His parents lived in Plattsmouth, so to cut out some of his daily drive time and to be a little closer to Leah who lived in Bellevue, he paid a very reasonable rent to my grandparents to stay in their basement. Unfortunately for Tom, who is perpetually cold in the winter anyways, the thermostat controlling the heat in his bedroom and the entire house was located in the living room, just across from the blazing fireplace. The furnace in that house virtually never turned on, so while my grandparents were watching 'Wheel of Fortune' in a toasty 78 degree living room, Tom would be downstairs in bed with a full on ensemble of sweats, stocking hat, mittens, and the whole nine yards, reporting that at times he could literally see his breath. Ahhh, good stuff.

Summer Before

My name is Derrick Antoniak, and this is my blog on being a medical student.

Right now it is July 5, and my first day of medical school orientation is scheduled for August 18. It somehow still doesn't seem like something that I'm actually going to do. I've been reading a lot about what the experience will be like, from the emotions involved with dissecting a human cadaver to the long hours spent studying the overwhelming amount of material thrown at us in the first few weeks, but whenever I think about it and try to visualize myself doing those things, it always seems like another version of me, not the one that is here now writing this.

I actually have known the exact date I would start med school since mid-September of last year. I applied to the early decision program at UNMC, which means I was to be accepted or declined on October 1. As that date approached, a lady in the admissions office who knew me pretty well from the previous year's admissions cycle when I had not gotten in, decided to save me the anxiety of those last two weeks. She actually called me on September 18 to tell me that they had met on my file and that she wanted to be the first to congratulate me.

It is wierd to think about how long ago that conversation took place and I am still looking forward to starting orientation in 6 weeks. Nonetheless, here I am. I have recently started a program online through UNMC called 'Fast Start'. It is a pre-matriculation program designed to ease the transition from normal person to first-year-med student. There is some orientation information on health insurance, emergency procedures, etc. along with a guide to the first year written by the new second-year students. There is also a short anatomy course designed to get people familiar with the terminology and with the blackboard system. I am also reading some books I found at Borders about being a med student and being a physician. Overall, I am trying to get ready for what will certainly be a life-changing time in my life.

This week I will go to work at 6:00 AM each day. I will wear the oldest jeans I have with a t-shirt and workboots. I will sweat, I will undoubtedly get dirty. At lunchtime I will eat a quick sandwich and then lay down on a dirty concrete floor to try to get a quick nap before going back to work. I will leave work with new holes and stains on my clothes, new cuts and bruises on my hands. I will swear and make jokes with my co-workers. And at the end of the week, I will get paid. Except for a few of my co-workers who know me well, I will seem like any other construction worker on the jobsite. None of the things I just described, however, will be included in a description of my daily routine in a mere 6 weeks. The scariest part is that I really don't know what will.

So, I am finally feeling that a seed of anxiety has been planted, and I'm sure that it will grow nicely by the time orientation actually rolls around. I hope that people will read this blog and find it interesting, but I don't really expect that, so this is mainly intended to serve as a journal. Hopefully, by the time I finish med school, I will have a valuable collection of thoughts stored here on this blog.