Bodies: The Exhibit

Dead bodies as entertainment. Not exactly a novel idea, but its something that has become pretty popular recently. You may have heard of it or, if the exhibit happens to be in a nearby city, perhaps you have had a chance to go and view Bodies: The Exhibit and/or Body Worlds. Basically, people have donated their bodies to be preserved by a process called plastination, whereby the body is filled with a plastic-based preservative. The effect is that the bones, muscles, and other tissues are are preserved almost completely. I'll leave alone the debate over whether or not an exhibit like this is ethical and why the general public finds corpses so captivating. However, when I went, I was surprised to see parents bringing their little kids along (less than 3 years old). I guess people like the opportunity to experience the mystery and intrigue surrounding anatomy class in medical school using cadavers.

As I mentioned before, the preservation methods are quite good. The exhibit is a mix of partially dissected bodies (showing an organ system) along with individual bones or organs in viewing cases for clarity. The complete bodies are positioned in some kind of active motion, like shooting a basketball or a runner in stride.

It was a cool prelude to actual anatomy class, which I'll get to experience next year. The up close view was a tease for someone like me. I will find it much more interesting in a hands-on environment (there were a number of times that I just wanted to pick something up and get a better look or know how it feels). The Nervous System section was a bit intimidating because I saw how fine and delicate the nerves are that permeate the body. Around your belly button, a number of nerves burst out of your spine and radiate outwards. I fully expect me and my fellow students to tear through a number of these while digging through muscle and fascia during dissection. I only hope we don't demolish too many of the ones we are supposed to identify! [Note: this is the reason why some med schools offer pro-sections, dissections done by a professional]
I was particularly interested in the examples of cancer. Their gross anatomy is highly reminiscent of the tumors I see in lab in our mice. I also liked the examples of developing fetuses with the different bone stains. You can really see how the bones (especially in the head and hands/feet) start out as separate entities and they grow together in place or can even fuse together. The developmental abnormalities, while tragic, were pretty cool to see (abdominal hernia and Siamese twins).
In all, I came away from the tour with even more anticipation for starting school. It was cool to know that while many people may get to see these preserved bodies, at some point I'll get to see things in real life, pulsing and breathing. If you get the chance, you should go.

Graduate School Survival Guide

Thanks to Ronald T. Azuma for putting together this informative and humorous survival guide for graduate school. I won't copy and paste his entire guide (not sure if thats even legal, much less ethical), but if his website ever goes down just let me know and I can post it here since I have a saved copy on my computer.

Graduate School Survival Guide

I think there are some points to garner from reading this. First, that you should be really sure about your decision to pursue a PhD (MD or not). Second, to know that academia is fraught with politics, so organization, communication, and planning are vital to your success. Take a tip from your business buddies and learn about networking early on in your career - those contacts will be useful in the long run! Third, be sure to show initiative.

Lord of the Rings: An Allegory for a PhD

Its good to know that there are others out there struggling as much as you in the graduate years. I'll try to keep posting 'em as I find 'em.

Source: http://www.jacobite.org.uk/dave/odd/lotr.html

The story starts with Frodo: a young hobbit, quite bright, a bit dissatisfied with what he's learnt so far and with his mates back home who just seem to want to get jobs and settle down and drink beer. He's also very much in awe of his tutor and mentor, the very senior professor Gandalf, so when Gandalf suggests he take on a short project for him (carrying the Ring to Rivendell), he agrees.

Frodo very quickly encounters the shadowy forces of fear and despair which will haunt the rest of his journey and leave permanent scars on his psyche, but he also makes some useful friends. In particular, he spends an evening down the pub with Aragorn, who has been wandering the world for many years as Gandalf's postdoc and becomes his adviser when Gandalf isn't around.

After Frodo has completed his first project, Gandalf (along with head of department Elrond) proposes that the work should be extended. He assembles a large research group, including visiting students Gimli and Legolas, the foreign postdoc Boromir, and several of Frodo's own friends from his undergraduate days. Frodo agrees to tackle this larger project, though he has mixed feelings about it. ("'I will take the Ring', he said, 'although I do not know the way.'")

Very rapidly, things go wrong. First, Gandalf disappears and has no more interaction with Frodo until everything is over. (Frodo assumes his supervisor is dead: in fact, he's simply found a more interesting topic and is working on that instead.) At his first international conference in Lorien, Frodo is cross-questioned terrifyingly by Galadriel, and betrayed by Boromir, who is anxious to get the credit for the work himself. Frodo cuts himself off from the rest of his team: from now on, he will only discuss his work with Sam, an old friend who doesn't really understand what it's all about, but in any case is prepared to give Frodo credit for being rather cleverer than he is. Then he sets out towards Mordor.

The last and darkest period of Frodo's journey clearly represents the writing-up stage, as he struggles towards Mount Doom (submission), finding his burden growing heavier and heavier yet more and more a part of himself; more and more terrified of failure; plagued by the figure of Gollum, the student who carried the Ring before him but never wrote up and still hangs around as a burnt-out, jealous shadow; talking less and less even to Sam. When he submits the Ring to the fire, it is in desperate confusion rather than with confidence, and for a while the world seems empty.

Eventually it is over: the Ring is gone, everyone congratulates him, and for a few days he can convince himself that his troubles are over. But there is one more obstacle to overcome: months later, back in the Shire, he must confront the external examiner Saruman, an old enemy of Gandalf, who seeks to humiliate and destroy his rival's protege. With the help of his friends and colleagues, Frodo passes through this ordeal, but discovers at the end that victory has no value left for him. While his friends return to settling down and finding jobs and starting families, Frodo remains in limbo; finally, along with Gandalf, Elrond and many others, he joins the brain drain across the Western ocean to the new land beyond.

Good Tidings

Man, after a crappy day in the lab its good to come home to some good news. My official letter of acceptance came in the mail. Unlike rejection letters, this is one small envelope I have been looking forward to receiving for a long time. I'm not going to open it though - I think I'll wrap it up and let my mom open it for Christmas (she's a big reason I decided to become a doctor, and even moreso to a physician-scientist).

I also made travel arrangements for another MD/PhD interview I have coming up in January. The nice thing is that they are paying for all my expenses on the trip. Like most schools, I was able to select a list of faculty members I would be interested in meeting. Although I originally found it a pain in the ass, I am now glad I took the time to do it. A large part of any MD/PhD experience will be decided by who you work for, so its important to identify some potential PI's beforehand. You don't want to wind up at a school and realize that there are few, if any, PI's that work in your field of interest. Luckily, this school had alot of successful PIs doing the kind of work I'm interested in (cancer biology/modeling) - more than I had known about before. Shows how a little research can be revealing.

I also got my GRE Subject Test score back from ETS. Yes, I was considering applying to graduate school this year, so I decided to take the tests in case I applied. I did pretty well overall considering I've been out of school for a while and my study preparation was erratic. I think I'm going to put my comments about the test, test prep, and what the results mean into a separate post because it deserves more attention.

Difference between MD and PhD

I found this good, although not entirely accurate post, over on the SDN forums.

By ScottishChap
M.D. - harder to get into, easier to get through, science classes just scratch the surface, can get by by memorizing like a parrot, not treated as a colleague, expensive, independent thought is dangerous, program lasts 4 years, instructors can't mess with the class mean without repercussions, students whine a lot more, students assume all Ph.D. students are unhappy med school rejects. Overall: subject matter is one inch deep and 10 miles wide.

Ph.D. - easier to get into, harder to get through, science classes take it as deep as current knowledge permits, will fail if all you do is memorize, treated more as a colleague, inexpensive, independent thought is rewarded, program lasts 3-7 years, instructors can make exams hard enough that the mean is 40% without repercussions, students whine much less, students assume all M.D. students are snooty and arrogant. Overall: subject matter is 10 miles deep and one inch wide.

Now, where does that leave us MD/PhDs??

In review

Good news today: my manuscript was approved by the journal's editors for peer-review. I'm crossing my fingers that the reviewers will like what I've written!

Getting Scooped

Success in academic medicine is largely measured by publications. In fact, we live by the code: Publish or Perish. This means that you either show your abilities in research by publishing articles in peer-reviewed journals or else you will be deemed unproductive, incompetent, and ultimately irrelevant in the eyes of your colleagues.

There is TREMENDOUS pressure to publish. Not only are you concerned that about showing some productivity (it can be years between publications), but you will also be intimately worried about the possibility of someone beating you to the punch and publishing the same findings first. Researchers call this "getting scooped." This is bad news because it means your research project has just gone from being cutting-edge to yesterday's news. Novelty is lost and it looks like the other guys thought of it first (regardless if you did or not), so they can then claim all the credit.

It may seem uncommon, given the immensity of science, that two or more groups would be working on the exact same research project at the exact same time. Heck, it might even seem counterproductive for research dollars to be spent investigating the same thing. [Note: I'll save the debate about competition in science for another post.] However, it actually happens all the time. Just think of Elisha Gray. Who is Elisha Gray? Exactly. He's the guy that got scooped by Alexander Graham Bell in inventing the telephone. Bell made it to the patent office only a few hours before Gray. Point of the story: Don't be like Gray, don't get scooped. Of course, this means living in perpetual fear whenever you start a project because you are worried about whether someone will have already started on it and thus have a head start on you. Or, there are always those people out there who work day and night, sacrificing body and soul, in pursuit of scooping other people (aka Gunners).

Although most academians claim to be collegial, I know few who are entirely open with their ideas and data, simply because of the possibility of being scooped. There will always be the eager grad student/post-doc/PI sniffing around for the latest great idea to steal and publish without recognizing the origin (unless of course she praises himself for her ingenuity). As an aspiring researcher, you should be mindful of this fact because you don't want to share more information than you want to, but you still want to maintain collaborations. I'll admit its a tricky balancing act that will take some time to learn and you'll probably get burned a few times before you know when to pipe-up.

Interviews Coming Up

Two interview invites in one week! I was surprised by one of them since it was from a school that had rejected me from their MSTP program, I figured I was out of the running for that school (private). The invite was for a MD-only program. I have heard many good things about this school, including its skyrocketing amounts of NIH funding being brought in during the past few years. It is also a school that has a modified Pass/Fail and Problem-Based-Learning (PBL) curriculum, which are very big draws for a person like me. But since it was MD-only, it would mean I would have to pay my way through school - this I didn't like. However, we are talking a difference of 4 years vs. 7-8 years in a MSTP program - it could be argued that the post-graduation income during that 3-4 year difference would make up for the cost of paying for school. It was something worth spending a little bit of time thinking about. Whats more, the school offers a 5-year program (tuition paid during MD and a stipend during a research year) that is also an attractive potential alternative to an MD/PhD (the program was created to accelerate physician-scientists' training). I figure that I'll go and check it out.

The second school is a large and successful public university and the interview is for their MD/PhD program. I'll admit that I'm nervous about potentially being one of the few non-in-state students in the medical school class and I wonder if the school's emphasis on public health affects the research side of medicine (and education). They have offered to pay for all expenses during the interview, which is nice. I have a couple of weeks to decide to go or not and I think it is worth being sure before I take these nice peoples' money and time.

Weird Dream

I had a dream last night that I was interviewing for medical school at a well-known university and surrounded by uber-competitive, Type A, overachieving, all ducks in a row, T's crossed, and i's dotted kind of students. I felt uncomfortable being around these strangers that were so gung-ho about everything they did in life. Somewhere between my staying with a student host and the actual interview, I ran away, confused and upset but then I woke up.

I'm having more of these kind of strange dreams lately in the lead up to medical school. Reading House of God probably got my psyche thinking about my return to school or it could be attributable to the stress involved in interviewing ( I have one coming up). Its definitely going to be a shock starting actual school again, given the different type of learning that is required in medical school compared to life in the lab. Its also going to be weird being around overzealous premeds-turned-med students, whose ilk I typically avoided as an undergrad. These gunner-types are at every medical school, utterly devoid of personality, but have managed to slip through the system and now are set on getting into the most competitive residency. Right now, it looks like I'll be going to a school that is Pass/Fail - so that is helping me alleviate my fears.

Book Report: House of God

There are a number of things that we do on the path to becoming physicians. Many of them, like taking the MCAT, passing organic chemistry, and submitting an AMCAS application can be considered "Rites of Passage." Among the litany of hoops that we jump through, reading the House of God by Samuel Shem is perhaps one of the most important things an aspiring doctor can do before starting medical school. Although a bit dated, the description of the realities doctors must face is essential for anyone considering the profession. Grey's Anatomy, ER, Scrubs, etc. really don't capture many of the horrors that real doctors must endure during their training. This includes dealing with incoherent patients, incompetent colleagues, and an endless stream of work that keeps you elbows deep in the body cavities of "gomers" (old people). Moreover, the stressful lifestyle begins to take a toll on your personality and relationships with others. The main character, Dr. Roy Basch, is a "red-hot" graduate of a prestigious medcial school and enters his first year of a internal medicine internship with all the best intentions. Through the relentless workload, overzealous and out-of-touch-with-reality Slurpers (kiss assess), and his own depression he loses himself and converts into a jaded and cynical doctor that hates himself and everyone else around him. The transformation is startling but understandable given the circumstances. The system just considers it "the way things are done" and doesn't take into account that times have changed and so have the demands of doctors. Something is definitely wrong with the way doctors are taught to take care of people.

I read the book because, like I mentioned above, it is a Rite of Passage that pre-meds go through - for good reason. The LAWS of the House of God are still quoted by practicing physicians and are worth knowing/thinking about. In particular, it is worth spending some time pondering the role of medicine in staving off death, but at what cost? Can treating a disease make things worse? What role do doctors play in death and controlling the autonomy of a patient over their own life? Although the book was written back in the 70's, we still don't have definitive answers to these questions, but more and more technologies are coming online that will let us prolong life without the necessary ethical considerations in place for administering end of life care.

I highly recommend that anyone considering a career as a doctor pick the book up, read it, and consider if you still want to be a physician. Like the Med School Hell blog, it will open your eyes to the career path that you are considering. Thankfully, there are now laws in place to prevent the insane workload imposed on recent intern/resident graduates - but these restrictions are not always followed.

Relevance Rating: 10/10.

Blog: Respectful Insolence

I'll admit that I'm new to this blogging thing and that there are a number of other, more experienced bloggers out there. One good one is written by Orac, an MD/PhD graduate now at the junior faculty level (finished grad school, postdoc, and has started a lab of his own) called "Respectful Insolence." He's got some great posts on the life of a physician-scientist and I'll link to some that overlap with the aim of this blog (no need reading the same thing twice, right?). A link to his blog is on the right.

Don't Smoke

If I ever need to be reminded of the world of medicine I'm about to enter, all I have to do is take the Patient elevators at work instead of the ones usually used by Staff. Today, I saw my first laryngectomy (I had to look it up) and it caught me off guard. Its not the kind of thing you see everyday. I didn't stare, but I did catch a good look. More than likely, it was due to some kind of esphogeal cancer - smoking is the likely culprit, but I cant be sure. I think that seeing the hole did more to dissuade me from smoking than all the Truth commercials I've ever seen.

Please don't smoke, it doesn't always kill you.

(Image source: www.microsurgeon.org)