Sunday, December 25, 2011

A very special Christmas

Merry Christmas and an early Happy New Year to everyone!

I'm a firm believer the world won't end in 2012, but I guess we'll find out soon enough.

This is not a regular Christmas for me. The end of this year symbolizes a small (but important) transformation in my life. Starting January 3rd, I'll be "working" in the hospital for my clinical rotations. Gone (mostly) are the lecture halls and didactics that have been my home for more than a decade. Now, I start my on-the-job training.

I've mentioned this a couple of times before - the clinics are something I've looked forward to for a long time, something I've worked towards for many years. But it also creates a lot of anxiety. I feel woefully inadequate to take care of patients. But people reassure me that the training I've received so far is much more comprehensive than I realize. That I am more prepared than i realize. That small consolation goes a long way.

Then again, I guess this kind of anxiety is a good thing. A little bit of stress does improve performance... but more importantly, it harkens back to an important lesson from my differential diagnosis class - don't assume you know everything about the current situation. This is the cornerstone for a good differential diagnosis: you always keep your mind open to other possibilities, and you force yourself to think of counter example - what else could it be?

By walking into clinics assuming I know less than I do, I'll force myself to keep my eyes and ears open. It forces me to be on my toes just a bit more. At a personal level, this means I'm hungrier to learn more. But the more important (and bigger) effect it'll have will be for my patients: I'll be taking second, third and even fourth looks over their plans, histories, results... the works! I'm hoping this second guessing will make me a better student now, and (eventually) a better doctor.

So here's to the end of a beginning and the start of a new phase in my education. On the job training isn't something new to me - I worked in the corporate world for 5 years before coming to medical school. But this is a very different animal. Sappy as it sounds: lives are on the line.

There will be many more "ends of beginnings" to come, I have no doubt of that. But I believe recognizing and respecting milestones (like this one, even though it's a small one) is crucial to the learning process.

This is a bit tangential (and if this is your first time reading my blog, you'll realize that I almost always have tangents in each post), but times like this remind me of what it takes to be a good doctor. For some reason, whenever I think of that, I'm taken back to a scene from Scrubs (one of my favorite shows).

This is one of the most powerful scenes from the show and it has stuck with me for many, many years. A great doctor is someone who is very invested in his patients... but knows the importance of staying objective. Walking the line and keeping tragedies from debilitating your work is not the easiest thing to do, but I believe it is an important lesson to learn. Here's hoping I learn it.

Enjoy the New Years! And if the world does end in 2012 - I'm going to be very sad because I'm JUST starting the really fun stuff...

- Karthik

Sunday, November 20, 2011

Let's recap

So what have I been up to since my last real post... It's interesting for me to look at this list and realize just how much happens in a med student's life in the span of a few months. This is in stark contrast to what I was accomplishing in my corporate life. I was definitely doing some awesome/fun things in my last life, but it was on a very different scale. I guess this is how I know I'm in the right place now?

1. Summer:

Over the summer I worked with inner city high school kids. I was teaching "watered down" medical science. But the main goal was to convince them to go to college. It was such a fun gig... I only worked 4 days a week (half time too!) and I got to teach! It was sweet!  The best part about the whole thing? This is how my students see me:

(the future surgeon part might be a bit of a stretch...)

2. My second year started! Each part of it sooo deserves it's own numbered bullet... As a side note - Penn Med is special - we start our clinics half way through our second year. So, starting Jan 3rd, 2012, I'll be in clinics! It seemed really close last year... and boy, it's a lot closer now!

3. Cardiology

This is one of our "tough 3" courses at Penn (the others are Brain & Behaviour, which we finished in January, and Renal - which comes right after cardiology).

And boy was it tough! For being a dumb pump, the heart is one complicated machine. Heart issues are also the #1 killer in America (and maybe the world, but I'm not sure about that statistic). It's difficult to describe, but a large part of my class absolutely loved cardiology (including me). As complicated as it is, if you really understand how the physiology works.... there's actually logic behind everything! (This is rare in medicine). Of course there are some things you just have to accept / memorize - but overall, it was so well run. There's a good chance this one course has pushed cardiology (mainly catheterization and electrophysiology) to the "top 5" things in medicine I'm considering.

4. Dermatolology

Putting dermatology between Cardio and Renal was the (second) greatest idea they had at Penn. This was a much needed break. The weird thing is, Derm is one of the hardest residencies to get into because it is so competitive; yet our class on Dermatology is only 1 week long and is pretty straightforward (the mean on the exam is a 100). They just hit us with the most salient points and keep things very simple (which is nice once in a while)

5. Renal

Ouch. I want to go back to thinking about the kidney as a black box that makes pee. I'm thorougly impressed by the amount of things a kidney does. It was pretty painful trying to learn all the things the kidney does (and the different ways the kidney does it), but at the same time - I'm so happy I've got not one, but two kidneys.

(btw, this is the third of the 3 hard courses at Penn).

5.5: Fall break!! This is the best idea they've had at Penn Med. They gave us a couple of days off after Renal. What did me (and 6 others) decide to do?

We went to the Bahamas.


It was pretty epic! Definitely needed that.

6. Pulmonology

This is our last honors/pass/fail class before we head to clinics (we've got a microbiology review class and a class on differential diagnosis before January, but those are pass/fail). It's supposed to be easier than what we've been going through so far... I really hope it's true. For some reason, I'm just so burnt out after cardio and renal. It's also that I'm ready to hit clinics. I'm having a very difficult time motivating myself to study. If this continues, the Pulm exam will not end well for me. Here's hoping I can concentrate over thanksgiving break. If not, I'll definitely be screwed 2 weeks from Monday.

7. Clinics - wth!?

On the one hand, I can't wait, but on the other hand... I'm mortified. I've learned a lot int he last year and a half, but I've got so much left to learn. And now it's time to learn while doing. Which is kind of scary. (Who am I kidding, it's madness, but it seemed to have worked for everyone else who's gone ahead of me...)

I've always been a big fan of the quote "courage is not the absence of fear, but rather the judgement that something else is more important than fear". This is the best picture I could find to describe it (and double points because it's a harry potter reference)

But in reality... this is a more accurate picture of how I feel:

Signing off. Hoping to make another post around Turkey time.

Thursday, November 17, 2011


Ok, so I feel pretty bad that I haven't posted since June. Not only has a lot happened, I don't really have any good excuse for not posting since June. Med school's definitely ramped up a bit in my second year, but yes - I'm still alive.

I'll get out a real post over the weekend, but for now, here's something I've been thinking about for a while - and maybe I'll elaborate on it in a later post:

We always say the sum is greater than its parts, but I'm not sure that's always a good thing. Let's take humans. If an individual cell gets infected, it'll release a bunch of Interferons. This is a signal to its neighbours to say "hey, I'm infected with something - look out!". It'll also tell our immune system to wake up and kick some butt. At the same time, the infected cell slowly destroys itself - the ultimate sacrifice. This self destruction means it is no longer a factory for the infecting organism. It destroys itself to protect its neighbours.

Then there are humans.

We are built from these parts. We (the sum) are supposed to be greater than our parts (these cells). I don't think humans are nearly as selfless as these tiny little cells. We bicker, struggle for power, and hurt each other. How far we've fallen.


Tuesday, June 7, 2011

3 for 1 deal

So it's been 3 Sundays since my last post.

Whoops!  But I have good excuses!  The first Sunday was the Sunday before our double-header-exam: Endocrinology & Reproduction.  The Sunday after that was during the memorial day weekend.  This last Sunday?  Well, that was just me being lazy.

But to make up for it - I've put up three posts (including this one).  I've been working on the two bulky ones - here and here - for a while now.  Hope you like them.  I think my next two will be on time and responsibility.

My limiting reagent (heh, heh) a little while ago used to be lack of topics.  I didn't have anything deep to talk about.  I'm not sure I have deep stuff to blog about now, but I do have something to blog about.  These days it's the lack of time (yay medical school).

In other news:

I think people are starting to read my blog now.  I mean like, real people.

I apologize if you expect to find some deep / serious commentary on this blog.  I doubt you'll find that here.  But I'll try to make it entertaining (mainly by including pretty pictures)!

If you do a google search for Penn Med and scroll down a bit... this blog is now listed on the first page.  My reaction to this is: "what... why!?"  I know they say any publicity is good publicity, but I'm not sure publicity is what I'm going for with this blog.

If you want to see something really funny - google image search Penn Med.  My group was trying to find some Penn Med related images for a presentation.. and... well, we couldn't stop laughing at the results.

As a bonus scroll all the way to the bottom of the image search results.  You won't be disappointed - it's pretty hilarious.

Edit/Update: this info is not correct. When I google search, it tailors search results for me so my blog shows up on pg 1.  But this isn't true for the general population! So my blog does not show up on google yet - this is a good thing!  But the google images part seems correct though.

Ok, bed time.  I am very, very behind on sleep.

Monday, June 6, 2011

[1/2] Finding someone (or something) to blame.

When things don't go well, we often look for someone (or something) to blame.  You could say it's almost human to do so.  But that doesn't mean it's the right thing to do, nor does it excuse the finger pointing.

As with most things I blog about, I started thinking about finger pointing and blaming people when I made the mistake of finger pointing and blaming people.

We were in our endocrinology block and our lecturer was pointing out the strong correlation between obesity and type 2 diabetes. Absentmindedly (not an excuse), I remarked "hmm, well it's the patient's fault isn't it?  We suggest lifestyle changes and nutrition changes when we catch them in the prediabetic stage, but they don't do anything about it, and end up with full blown [type 2] diabetes".  

Harking back to an older post, this is when having good friends who will call you out is very important.  One of my close friends got on my case for having such a "blame the patient mentality" (which I don't, but I still deserved to be called out for my comment), and I got to thinking about the "blame the patient" mentality.  

I guess two things need to be clarified:

1. Blaming is just plain silly:
It doesn't do anything about the situation.  It just makes people feel bad and it causes resentment.  All of which are barriers to improvement - which is what we should all be struggling towards.

2. Blaming implies judgement.

No one is ever in a position to judge anyone else.  

2 (addendum): As doctors, our job isn't to judge: it's to heal and maybe even prevent.

But all of those have to be separated from the concept of a root cause.  You always need to search for the root cause.  But it has to be done without blame.

It's analogous to working very hard on something, but being detached from the outcome (as the buddhists and hindus say).  It isn't easy to do, since the work itself (eg. studying for an exam) tends to attach you to the outcome because the outcome tents to be a big driving force (eg. doing well and getting an A).  It is very easy to forget you are working hard because you want to, or because that's what the task deserves.  In the case of medical school exams - it's the idea that some patient in the future may need you to know that tiny detail that could change everything about his diagnosis and/or treatment.

It's similar in root cause analyses.  You work hard to find the root case, and when you get to the "end", it's very easy to try and blame the cause on something.  But it's almost always better to focus on how to deal with the cause.  Dealing with the cause doesn't mean you blame the cause.  In this situation, there's a tiny detail that might make it easier to not blame - to not get attached to the outcome.  The reason you started looking for and analyzing the root cause is to help a patient.

Blaming the patient does not help the patient.

Here's an example: obesity is highly correlated with T2db (type 2 diabetes).  One of the major reasons we have an obesity epidemic is because of the amount of junk food that's (cheaply) available coupled with low physical activity.  Blaming people doesn't do much.  But pointing out that it is something that can be controlled by each and every American is important - we need to empower people to do something about it.  But we have to do it without blaming them.

It is very important to tell our patients that controlling T2DB progression is in their hands.  Weight and exercise will prevent / prolong the onset of T2DB damage.  Contrast that to something like Huntington's disease: the patient has little to nothing they can do to halt it's progress.  So we need to present them with the information, urge them to follow it, but not blame.

I guess my point is it's a very thin line between falling into blaming the patient for something and pointing out these points to improve the patient's life.

I guess it's the difference between

"You have t2db because you are fat.  It's your fault, and you should change how you live"


"Your t2db is probably caused by your obesity.  I can give you some medications for this, but the best way to control and reverse this disease is by lifestyle changes.  But to do that, I'll need your help and your commitment to these changes. I am here to help you through this, so let's talk about what we can do to get you to a healthier lifestyle."

Not judging?  Check
Actually trying to help the patient? Check.

[2/2] Finding someone (or something) to blame.

In my other post, I talked about blame and finger pointing and why they are bad ideas on a philosophical level.  But does that mean fingers shouldn't be pointed?  Am I saying that people who make mistakes should get off without any repercussions?  No.  But I think it needs to be done in a productive way - I like to focus more on the end goal.

As doctors - you need to be hyper-aware of your mistakes.  The best way to describe it is "For everyone to whom much is given, of him shall much be required." -- Luke 12:48.  (Before people get confused, no I'm not Christian).  The "popular" way to interpret this is "to those whom much is given, much is expected".

Much is given to doctors: in many cases it is people's lives.  Thus (understandably) much is expected.  The only way doctors can hope to live up to these expectation is by being very aware of any mistakes that happen, realizing the root cause, fixing it, and making sure it doesn't happen again.  This is very important in the medical field because the question of mistakes happening is not an 'if', but a "when'.  I am not an idealist, so I understand that the steps I mentioned aren't always possible in every case.  For that to be possible, we'd need to understand how everything works... and we are far from that.  Medicine is called an art for a reason.

But this doesn't mean you don't try.

You don't point fingers at the doctor.  You talk to them - about what happened and about how to prevent it in the future.  As part of this process, the doctor has to own his/her mistake.  It's the only way they can improve.

As a side note - here's a good article about why mistakes are a very important part of the learning process. The only issue is that in medicine, mistakes are usually very, very costly.

Bottom line: the doctor, nurse, any healthcare worker (really anyone) who "points" at the doctor to blame him/her should do it in the spirit of trying to improve healthcare.  Not in the spirit of trying to find incompetence.  I'd like to think that most healthcare workers are pretty competent.  Or maybe that's just my naivety?

As patients - (this will be from the perspective of a healthcare worker more so than as a patient) as much as doctors try to help patients with health issues, at the end of the day it is up to the patient to meet us half way (usually it's more like 75% of the way).  Doctors cannot help patients who don't want to help themselves.

So ask yourself what you are trying to accomplish.  Blaming the patient is bad for quite a few reasons (the focus of my other post).  In my view, the main reason it's bad is because it doesn't encourage them to fix the situation.  If your job is to help people (and if you missed that in the job description, let me clarify: that is your job), healthcare workers need to find a better way.

Step 1 of that better way is to have an open and honest conversation about repercussions.  "I'm concerned about your LDL levels and triglycerides being so high because it really increases your chances of having major heart problems.  And there's a good chances they'll occur earlier rather than later in life".

Step 2 is working with the patient to figure out how they can fix the issue.  I'd love to have a one-size-fits-all approach to patients.  Take the issue of healthy nutrition / lifestyle for example: if we could just hand them a card that says "do xyz and abc, and you'll do great!" - that really would be great.  Problem is: it won't work for everyone.  As time consuming as it is, we have to work with patients - ask them how their lifestyle / diet is right now and what they would be willing to change (which usually means what causes the least inconvenience).  No one is going to massively change their lives.  This is especially true for preventative measures - few healthy people will take warnings seriously because... well.. they think they are healthy now so they'll be fine forever!

Bottom line: don't blame.
(1) Tell them you are concerned and what the consequences are
(2) ask them what their current situation is
(3) suggest (or refer to someone who can suggest) changes that wouldn't perturb their current situation too much.

Repeat as necessary.

These are just my opinions - a doe eyed first year med student.  I'm sure people have more advise on the matter (especially the more seasoned veterans - aka real doctors) - and if you do, leave a comment or two!

Sunday, May 15, 2011


This Wednesday, Penn hosted the Humanity Gifts Registry's annual Celebration of Remembrance ceremony.

This is a ceremony "for the individuals who have provided their bodies for one final service to their fellowmen - the contribution to Medical Education and Research".  Anatomy isn't something you can learn from a textbook or a professor.  I mentioned this in my blog post after our last anatomy class too.  My class (and other medical school classes from around the city) was happy we had the chance to show the family of these brave donors how much we appreciated our donor's selflessness.

I was lucky enough to be one of the eulogizers during the ceremony.  I was also the first eulogizer (no pressure!) Fortunately, I had an awesome set of friends who helped me craft a great eulogy - thanks Asmi, Jon, Anna, Paul and Eric!  I couldn't have done with without you guys.  I can't think of a better way to express my gratitude to our donors than the speech, so here it is:

In my culture, we have an old Sanskrit adage: “Matha, Pitha, Guru, Dheivum.”  Translated, it means “Mother, Father, Teacher, God.”  Like any saying that has deep religious and spiritual roots, the literal meaning of this phrase has been argued for a very long time.  To me, it emphasizes the importance of teachers in our lives: like our mothers who teach us to play nicely with our siblings; our fathers who teach us never to start a fight; or our friends who teach us to love and share with one another. In the classroom, we may learn from a professor, or from scripture.  We also learn from our classmates, like a friend who reminds you that the hip bone’s connected to the leg bone might not be the most accurate way to describe a leg joint. We all have many teachers, and they all share common traits: they shape and form us; they guide our conscience and learning; and they ensure that we stay true to our values. In short, they help us grow: intellectually; professionally; and personally. At the core, these are all examples of paying it forward: by educating us, they show us how to make a positive impact on the world.  Maybe this ripple effect on the student’s life, as well as all other people with whom the student comes into contact, is why my culture associates teachers with divinity. 

To say that each of the donors that we honor today is a teacher is an understatement.  In my medical school alone, each donor has, in one way or another, helped instruct 168 students. I don't think I'll ever have another class as amazing as Anatomy.  I'm extremely humbled and touched that people have donated their bodies to science so we can train to become the best doctors we can be.  I would like to take a moment to thank the people and their families who make Anatomy possible.  Thank you all, so very much.  Be assured that our class (and medical school classes around the world) has learned an immense amount from our donors, lessons we could not have learned any other way.  Know that our ability to improve or save lives in the future stems from the willingness and commitment of these selfless people, and their families, to our continued education.

What I didn’t realize then was how our donors stay with us long after our Anatomy class.  Even in our classes now – where we are learning about renal artery blockages, vericoceles, or cerebral vasculature with the circle of Willis, I stop and think back to my anatomy lab and recall what the relevant structure looks like.  The anatomy experience allows me to visualize the pathological process that is happening and how it fits into a patient’s illness and treatment.  This exercise cannot be effectively learned from a professor’s lecture, a classmate’s explanation, or a textbook; it would be impossible without the contribution from our donors. Every patient we meet teaches us something. We consider our donors to be our first patients: their impact on us will, without a doubt, stay with us for life.

At the same time, I do not know who these donors were in life.  But you do.  They were fathers and mothers, brothers and sisters, sons and daughters.  They were friends.  As Pericles said many millennia ago: “What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others.”   I am sure every one of these donors had an impact on your lives.  But only a select few can make a substantive impact even after they’ve left this world.  We will soon read aloud the names of each donor, and every single person on that list is part of that select few.  Their nobility will not be forgotten, and their selflessness will continue to be greatly appreciated by us, and by our future patients.

Thank you.

Sunday, May 8, 2011

Random thoughts

This has been an interesting week and weekend.  A lot of stuff happened (some good, some bad) - you'd think I'd have things to write about after it... but oddly I don't.  I'm not sure if my brain is just shutting down, but the whole week just seems like a haze.  I know stuff happened - but I'm not quite sure what they were.  Hopefully this happens to everyone at some point.  If not I'm either (a) getting really old or (b) need to seek medical help.

On a side note: one important thing we learned this week is never say a patient died "because they are old".  If your boss asks you "why does the patient have these issues", don't answer "because they are old!" That pearl of wisdom had us cracking up for a while.

We learned about the physiology of coitus (yes, seriously).  This was a nice capstone to our earlier lectures on how to build strong, positive relationships.  That earlier lecture on building good relationships was amazing - I feel like those were 2 lectures everyone should watch.  It can, quite literally, change your life.

Have I mentioned I love medical school?

Two more things:

1. Happy mother's day!  More than that, I want to say thanks to all the mothers out there.  We wouldn't be here if it wasn't for you, and we wouldn't be the people we are if you weren't "lovingly encouraging" us to reach our potential.  Keep it up!  We may not be able to thank you as young kiddies, but we will once we are old / mature enough.  Even if we don't say it, we appreciate you being there for us - don't ever stop.

2. We've got a remembrance ceremony coming up.  This is for all those great souls who donated their bodies to science so the medical students can learn anatomy and human physiology.  I'm humbled and honored to be a participant in the ceremony.  I feel like anything we do to thank them will pale in comparison to what they've done for us (and for all of our future patients), but we are going to try anyway.  Hopefully things will go well on Wednesday, and their families will see how much we appreciate what our donors have given us.

Ok, I'm running on 4.5 hours of sleep (not because I was studying) - time to catch up !

- Karthik

Sunday, May 1, 2011

How to not rust

Whenever we learn about an illness in medical school, we also talk about the etiology - the origin of the disease.  The etiology almost always includes a combination of: genetics, environmental factors, drugs, and sometimes, nurture.  What we don't talk about as much is how these things interplay in curing illnesses as well.  Maybe we'll talk about it a bit more later on, but for now it's usually "Drugs X, Y, and Z; get lots of exercise, eat well; and have a supportive family".  

Over the last few weeks I was thinking about how environmental factors continue to shape us as people.  Specifically, the friends, colleagues and classmates we have around us.  I don't know about you, but for me, where I went to school played a huge role in selecting the friends I had growing up.  And it continues to do so.  Coming to an amazing institution like Penn Med means the friends I have around me are equally amazing.  

One of the reasons it matters so much to have good people around you is because they are there to set you straight when you make a mistake.  It's never really about the mistakes you make, it's more about how you deal with the mistake and handle its repercussions.  That part's hard, sure - but the hardest part is knowing that you made a mistake in the first place.  This is where good friends come in: they care about you enough to call you out on your mistake and then stand by you and help you handle the fallout.  

The reason I've been going over this in my head is because of the field I'm entering.  A field where (a) mistakes happen (although we really wish they wouldn't) and (b) handling those mistakes are so crucial (because lives hang in the balance - sometimes literally).  Often in our ethics class we are asked "If gold rusts, what will iron do?"  As doctors, we'll be held up to very high standards and it's important to practice not-rusting as early as possible.

Obviously, you don't keep good friends around you just so they can call you out on your mistakes.  They are good friends because they do it without you asking or expecting them to do it.  This is why it's important to surround yourselves with wise people that you can also call your friends.  The environment always matters, and it'll continue to matter.

Now of course, you are probably asking yourself "wait, then why do people keep you around?"  Well, wise people need to laugh too.  And I'm one hell of a comic relief.

P.S.: New rule - new blog post every Sunday!  Let's see how long I can keep this up :)

Thursday, March 24, 2011

Letter to mother nature

Dear Mother Nature,

Snow in late march (25th) is now how I picture the 5th day of spring!  Please review your calculations, wind direction, precipitation and temperature values and recalibrate!  I want sun!!

Thanks in advance!



The response:

Dear inconsequential little person taking up otherwise useful Carbon,

No.  You pollute my planet, just drop your Carbon emissions when you come in the door and don't bother to clean up after yourself?  You can deal with the effects yourself.

You know I love you, but sometimes, you and all your siblings just need to learn to clean up after yourselves!

With tough love,

- Mother Nature

P.S. I hope you are prepping for that crazy party in 2012!  With the way you guys are handling things - that party is definitely happening.  Just sayin!

Spring's here?  Lies.

Sunday, March 13, 2011

Fast forward a month

How do you know Brain & Behaviour (the first part) is one of the most painful 4 (ish) weeks at Penn Med?  Because I haven't written a new blog post in a whole month.

I usually use my blog and Facebook (mostly Facebook) as my procrastination tools against studying. I had so little time that I could only terrorize people on Facebook and not here.  Ah, good times.

But hey - that part of B&B is over.  And even my Spring Break is over now!  It's one of the few times I'm sad that a weekend has rolled around - because that means my fun times of sitting on my butt doing absolutely nothing for a whole week are over.  But such is life - just as the really painful and challenging parts of life pass with time, so do the good times.  Would be nice if you got to pick which pass and which don't though.

So what's happened in the last 4 weeks?

- Spring break just ended.  I decided to take it really easy and do nothing.  At. All.  Fyi - best decision ever
- In ~3.5 weeks, we learned almost everything (anatomical) about the brain and spinal cord.  That means all the tracts in your spinal cord and brain that carries info up and down.  We learned about what most of the little bumps, lumps, and fissures in the brain represent.  
- If there is a lesion in your brain / S.Cord that's causing symptoms, I should be able to tell you exactly where it is (like down to a 1x1x1 cm^3 region!)  
- When I look at MRIs / CT scans.  I can actually identify stuff now!  I can't tell you what's WRONG or what's causing the issue per say (like what kind of tumor it is etc.), but I can say when something's not right!

So I basically went from this:

This is an MRI of a person's brain right?  Is that white stuff supposed to be in the middle?

Being able to pick out each and every one of those structures.  And knowing what they all do and how they all connect.

And if I remember correctly, this was one of the easier MRI labeling pictures.  So when I say we learned a massive amount of information in those 3.5 weeks - I'm not kidding.

(Both images are from our Nolte's The Human Brain book - a really great resource for a class like this.  It was a required book, and it was highly recommended that everyone actually buy the required text book this time.  Because of some bad luck, I ended up not getting my hands on this book.  But that's a story for another day.  If I do well in B&B, it'll be a miracle)

Also, side note - you'd think that different people have "unique" brain structures right?  Apparently not.  Most people's brains are very, very similar in which parts do what (and their relative sizes!)  Actually - if your brain isn't like the "normal" brain, it usually means there's something wrong (and not in a good way).  But usually your brain can compensate for a few of the issues.  Really amazing stuff.

I did write up outlines for a couple of blog posts that are not related to academics.  I'll flesh them out and post them up as soon as I get to it!

Thursday, February 17, 2011


This is your brain:

That's what I'll be learning about for the next couple of months.  For about 4 weeks, we'll be doing the anatomy of the brain, brain stem and spinal cord.  After that is spring break (whoo) and then we'll come back to do the "touchy feely" stuff - which is the behaviour / psychology part of the Brain & Behaviour course.

B&B is apparently the hardest course at Penn Med.  Period.  And I thought my last class (MDTI - mechanisms of disease and therapeutic interventions) was bad.  The only redeeming quality is that the material is totally super awesome

Unfortunately, it's only been a week and a half and I'm already a few days behind in class.  This is after putting in 5+ hours every day trying to keep up (ok, I completely goofed around the last weekend and did no studying - so maybe that's why, but it was totally worth it!).

Getting slammed by this much information makes me feel kinda small and stupid.  I mean, yes I understand this is really complicated stuff, but my mind doesn't seem to care.  As of now, this is how my brain feels:

Here's something interesting I've gotten out of the last week and a half.  There is a sensory homunculus in the somato-sensory cortex of the brain.  When all of your senses come back into your brain, they are brought back in a very careful way so a map is made of your body.  So if you stimulate your toe, one specific part of your brain lights up.  Stimulate your pinky, a different part lights up.  This map of your senses is called the homunculus:

The brain has a big fissure in the middle that goes from the front to the back of the brain.  The homunculus is approximately the same on the left and right side of the brain (representing the right and left side of the body). 

Speaking of your toe - ever wonder why foot fetishes are so common (actually, I think they are the most common "deviant" sexual practice)?  Take a close look at the medial part of the homunculus - professors joke that it's like your "feet are dangling over the edge into the deep parts of your brain".  Well - there's something else dangling down there too: sensation from your genitals.

Referred pain and crossed information pathways leading to "misplaced" information is not uncommon in the brain.  Sensation from the toes is very closely placed to sensation from the genitals.  So if you stimulate your toes... let's say "vigorously", I can see why some cross stimulation might happen in the genital part of the homunculus map.  It's also possible that some people have an unfortunate (or fortunate, depending on your perspective) cross in neuronal pathways leading to a large overlap in the toe/genitals map.

So there you have it, a possible biological reason why foot fetishes are so common. Am I backing this up with scientific studies?  No.  Conjecture is so much more fun for topics like this.

Learning about brains is so awesome.

Wednesday, February 9, 2011

I have the coolest sister in the world (+ miscellaneous MDTI thoughts)

The week of Jan 31st wasn't the greatest for me.  I got some bad news from family and then from friends.  But time's always moving forward, so I worked through everything.  Having the MDTI exam on 2/7/11 wasn't something great to look forward to either - it meant the weekend before that was completely devoted to studying.  

But there was a major high point.  My (rakhi) sister AS stayed up till like 2 am Tuesday morning baking me ~4 lbs of brownies and cookies.  She overnighted them to me via FedEx (took me a while to actually pick it up though).  That definitely perked me up.  Here's a shot of what they look(ed) like:

Usually it takes me forever to finish eating baked goods, but thanks to the impending MDTI exam (= stress eating) + studying with LV (= 2x stress eating), the baked goods were all gone in 1 weekend!

Thanks AS - you really made my week and weekend!  You are the best sister ever!

This post was actually supposed to be posted before the MDTI exam, but I (for once) decided to be good and not distract myself.  So it might be a bit odd to put up this post after MDTI ended... but anyway - one of the things we were learning about in MDTI were chimeric proteins.  These are proteins made by combining different parts of different proteins (so they have partial functionalities of all the proteins).  Most of these are very bad ass proteins - like Rituximab which specifically hits B cells, or certain TNF-Alpha inhibitors.  

Now, I know chimeric proteins are supposed to look something like this:

Or this:

But in my head, I always think chimeric proteins are kinda bad ass.  So instead of seeing the shapes above, I see this:

Am I the only one?  I think it's a much more accurate representation of fusion proteins!

On Tuesday (after we partied really hard Monday night to celebrate the end of MDTI) we started Brain & Behaviour.  This is apparently one of the most difficult classes at Penn Med.  But it's also one of my favorite topics in biology.  Somehow, it feels like a Clash of the Titans moment (I'm not really a titan, at all, but you get my point).  

I can't believe how fast time is flying by.

Friday, February 4, 2011


I don't quite know how to explain how painful the MDTI exam on Monday will be.  I think this picture does a great job of expressing how I feel:

On top of that, I'm distracted by images like this in my notes:

That, and silly jokes like how URAT1 sounds like a text insult - reading it out as "You are eighty one!" - definitely do one thing: keep me engaged with the subject material.  That's about 90% of the battle after studying for 6 hours straight.  Good times.

I know I'm studying too much when:
1. I haven't played video games in almost a week (rockband counts as a social activity, so I'm not counting that here)
2. I stopped making my bed in the morning.

Hmm, I know at least one person who'll be happy to hear about #1 (hi mom).

(For those of you who went to the Gout lecture - you'll see what I did there...  If you don't, /facepalm)

P.S. - For those who don't know me well: I'm actually not that stressed by MDTI.  It's just something to write about because it is taking up so much of my damn time right now.

Tuesday, February 1, 2011

No regrets, and why missing class is bad (aka Karma Continued)

I skipped out on a CDM (clinical decision making) lecture last week.

Usually I'm a goody-two-shoes: I skipped class once last semester (that was to go see a patient - I'd say that's a good excuse).  I skipped class(es) once this semester - and this was one of the lectures on the day I skipped.  Ok, this time I didn't really have a good excuse - but hey, lectures are recorded, so I figured I'd look at it later.

And, of course, this lecture had one of the most important lessons I'll learn in med school (thanks Karma): No regrets.  More specifically, it went something like this:

"You can't control outcomes no matter how much you want to.  You make the best informed decision you can but bad outcomes are inevitable. If it doesn't turn out well, you'll feel guilty.  But the thing about making an informed decision - making a good decision - is that you won't (or shouldn't) regret the decision."

At least that's the theory: hell, I'll take it.  (Obviously I paraphrased what the lecturer said.)

This is an extremely important lesson that people need to learn in life, and it goes doubly, quadruply, 1000xuply for (future) doctors.  The "bad outcome" is pretty damn bad in the healthcare field.  So it's that much more important to make sure you make an informed decision.  And it's that much more important to not regret the bad outcomes.

Ok, clearly this is probably not a good decision in the first place, but it is funny. So there.

And of course, Karma did what it's famous for: it always gives 110%.  The professor was talking about how pharmaceutical companies use Willingness to Pay analyses to set drug prices.  At one point he asked "anyone worked in pharma?  As a consultant maybe?" and most of the class (that was there) was looking around to see where I was.  One of the few times my experiences are actually useful for a session... and I'm at the Verizon store upgrading my phone.  (In my defense, I was | | close to throwing my old phone over a bridge.  The Samsung Omnia was great when it came out - before the iPhone.  So in this day and age, it's a really crappy phone).

In reviewing the lecture today (and boy was it an appropriate day to do it... was/am having a pretty bad day), I have to say - Karma was actually on my side for a change.  It's not that I haven't learned this lesson through the school of hard knocks.  But hearing it from a lecturer makes it so... official.

And being reminded that you don't have to regret good decisions (regardless of the outcome) is always nice.

Of course, there's always that little detail: knowing that you made the right decision(s).  I work very hard to make sure I say the right things and do the right things.  I'm a good guy.  But when something goes wrong... I always have this guilt.  I was in control of the situation - or played a big role in the situation... therefore it could have somehow been my fault.  Something I didn't account for.

I know I beat myself up more when things go badly than the average person probably does.  But it's always important to separate the learning experience from the regret.  It's also important to remember that the outcome isn't always in your hands - no matter how hard you try or how informed / good intentioned your actions are.

I'm still working on it.  I'm still learning.

So at the end of the day, do I regret skipping class?  Nope.  Did it have a bad outcome?  Yes (but fortunately: no one died, and I didn't completely miss the boat - yay recorded lectures!)  It was the best decision I could've made at the time (hindsight's 20/20 so it doesn't count).  And since a picture is worth a thousand words (even if the picture is just a bunch of words) - here's how I feel about missing that lecture.  Here's how I feel about (most of) my actions in life:

In other news - my MDTI (Mechanisms of Disease and Therapeutic Interventions) final exam is 1 week from today.  This is the amount of information that will be tested:

I'm not going to let this stand in my way.  I will destroy this material and become the best damn doctor I can be.

Bring it on.

Sunday, January 23, 2011


It's hard to believe that school has only been in session for 3 weeks.  I'm pretty convinced my brain isn't built to handle the amount of information being thrown at us.  The scary thing is - this is how our school is "easing us into" this semester: the next class we take - Brain & Behaviour - is supposed to be a lot worse.  Oh joy.

And yes, I spell behaviour with a u.

At the same time, there's nowhere I'd rather be.  Where else does this happen:

Professor: "So the malignant cells invading into the tissue look like really long tongues digging deep into the tissue"

*We look at each other, start giggling, and then start laughing uncontrollably*

Professor: (initially confused, then looks at the slide, looks back at us and says) "You have really sick minds"

Which makes us laugh even harder.

On the flip side, I'm pretty sure I'll never forget what a malignant neoplasm looks like when it's being... malignant (i.e. invading normal tissue underneath it).

At the same time, this is the same class that gets moved to tears by the Alex's Lemonade Stand story.  We had Alex's parents come talk to us about Alex's experience with cancer and how she set up a lemonade stand to raise funds not to help herself - but to help other kids with cancer.

Alex raised $2000 in one day.

This is the kind of talk that reminds us why we are in medical school - what we are fighting for.  Seeing my class go from giggling at pathology slides to being moved to tears by strong stories is oddly inspiring - I don't know if I can explain it.  Seeing their resolve to plow through this material so they can one day make a difference in people's lives inspires me to stop procrastinating and do the same.

Now I just have to figure out how to break the following cycle and I'll be the bestest med student EVER:

Monday, January 17, 2011

To teachers who are no longer with us

On Thursday, Jan 13 2011 our class heard that one of our Genetics professors (who was also a small group discussion section leader/preceptor) had passed away.  Dr. Thomas R. Kadesch.  

When I saw the email, his name sounded very familiar (we have many, many professors who teach our classes - sometimes just a lecture or two), so I googled his name and saw his picture.  My first response was "he's the guy who taught me about Retinoblastoma"!  He was not my small group preceptor, so I didn't know him very well.  But I did remember almost everything he taught us about Rb (think of that as either the protein or retinoblastoma itself).

Rb is a pretty rare disease.  But considering how many students Dr. Kadesch has taught (in just our year, that's about 165 kids), I'm sure one of us will end up diagnosing a patient with Rb.  I know that if I end up being the one who diagnoses a patient with this cancer, know this: it won't be because I'm smart, or because of any inborn talent of mine.  It'll be because Dr. Kadesh taught me about this disease.  Him and all the other professors who lectured to us about this cancer.   

Good people in the world live on through their deeds.  For teachers, this is doubly true.  Their impact on students continues to help the world long after they are gone.  Thank you Dr. Kadesch.

My condolences to his family, friends, and my fellow students (especially the ones who had him as their group discussion preceptor).

As a side note, as I was writing up this blog post, my music playlist started playing the "Aeris Theme"  (or Aerith if you played the Japanese version) from Final Fantasy VII.  For those of you who know it, you'll understand why it's appropriate.  For those who aren't familiar with it - give it a listen.

Even if you don't know about FF7, I'm pretty sure you'll understand why it's appropriate.

Rest In Peace Dr. Kadesch.

Sunday, January 9, 2011


So, as always, instead of going to sleep - I'm up writing a blog post.

For some reason, Karma's been on my mind the whole week.  As an unintended physical manifestation of my musings (thanks life!), I ended up getting hot chocolate and a muffin at Good Karma earlier in the week, and I had dinner at Karma Restaurant & Bar over the weekend.  I don't frequent either spot (not because they aren't good - they are both pretty awesome actually).

Translated, Karma means action (more aptly, "to do" if I remember Sanskrit right).  I've always believed actions speak louder than words and place great importance in action.  Of course, the pop culture interpretation of Karma is along the lines of "beware what you do, because [karma] will come back and bite your ass".  I don't know if I believe in that - I've never been a big fan of "do the right thing so good things happen to you".  I prefer "Do the right thing because it's the right thing to do".

So why has Karma been on my mind?  It's because I don't know if I'm doing the right thing these days.  School's piling up a lot of work.  That means the precious amounts of free time I have left is spent watching TV / going out to party with local friends.  That means people who are important to me that aren't nearby fall to the wayside: I've talked to my parents once this week.  My (rakhi) sister only once and texted a couple of times.  Let's not even talk about me keeping in touch / being there for my close friends outside my family.  All of this isn't unexpected - I'm in medical school, it's going to be a lot of work and a lot of pressure.  I know it, my family knows it, and many of my friends probably know it and understand as well.  I guess the issue is I'm feeling slightly guilty I'm prioritizing things like TV above keeping in touch with people.

Beyond that, I'm also at a certain crossroads in my life right now (it's got nothing to do with school).  It's a crossroads I've been to before, and I'm pretty sure I'll choose the same path... again... and it is not a fun path to walk (yes I know I'm being cryptic).  And I don't know if it's the right action.

I do the right thing because it's the right thing to do.  But when I'm concerned I may not be doing the right thing... that's when I start worrying about the second part of Karma: that it comes back to smack me over the head.

I just have to remember that at the end of the day, I can only do the best I can.  I have to trust that I've got a strong moral & intellectual compass.  Because the conquest of Karma lies in intelligent action.

In other good news - I started my p90x workout regimen again.  Whoo!

Thursday, January 6, 2011


So, as of Jan 3rd (M), I started my second semester at Penn Med.  For the first month, we are taking 1 main course - MDTI (Mechanisms of Disease and Therapeutic Interventions) and a couple of other "touchy feely" classes (Ethics and Clinical Decision Making).  Ok, CDM isn't really touchy feely, it's probably pretty damn important - but MDTI is the meat-y course for this month.

And damn there's a lot of meat.

I spent about 3 hours yesterday trying to catch up on my notes from MDTI.  I was so excited I finally figured out the blood coagulation pathway (it's the one with all the crazy factors, which all have roman numerals and are completely out of sequence).

Then I realized... that was ONE lecture on Monday.  I've still got 1 more to go through.  And I've had on average 2 lectures each day.  So I've still got the lectures from Tuesday and Wednesday to catch up on.

FML is the only thing that comes to mind.  It's clearly not as bad as it could be (if you want to feel a lot better about your life - definitely checkout the FML website).  So I guess this is "real" medical school.  I am soooo not prepared.  Thanks to the holiday week (and a half) I've also forgotten how to maintain a good sleep cycle, so it's writing checks my body can't cash.

In other good news: I (finally) followed through on my New Year resolution - to restart my workout program.  I don't have lofty goals of getting a six pack or anything like that (although it would be nice obviously).  I just really wanted to restart P90X, especially since I saw great results the first time I did it.

So what did I find out?  I've lost a lot of muscle in the last 6 months that I haven't really worked out.  Can't lift my arms over my shoulder right now.  Yay chest & back.  That means I have to do plyometrics today (jump training) - which is "the mother of all p90x workouts".  Yea... let's see how long I can keep this up...

Saturday, January 1, 2011

Happy New Years everyone!

And so another decade ends and 2011 begins.

I remember my 2010 new years eve - I was at Bowrey Electric in New York City with a few of my friends.  It was an odd new years for me because 2010 was the year I'd start medical school - something that I'd been working on for many years.  But I didn't know where that would be.

Now, for 2011, I spent a quiet New Years Eve with my parents at home (like any good new yorker, I got faaaar away from the ball drop well before New Years Eve).  And I know exactly where I'll be for the next few years (yay Penn Med).

Here's raising a glass and hoping every year gets better.  Happy New Year everyone.  I hope and pray that everyone has a great 2011, with many more glorious years to look forward to.

For my engineering buddies out there - happy 0x07DB.