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Monday afternoon found me wandering from building to building in the research park, clutching a bag containing a slip of pink paper and someone else’s urine sample in one hand and my car keys in the other.

Let me back up.

The summer between first and second year of medical school is really the last free summer of my academic life. This isn’t really too traumatic from my perspective, since I’ve already been a part of a workforce that doesn’t get a two-month vacation every year. Still, for many medical students, these eight weeks (ten for last year’s class, and how is that fair, I ask you) mark an important transition on the way to adulthood.

There are a lot of ways to spend this final summer. Some students go abroad to do research or learn a new language. Some put their feet up and embrace laziness for the last time in the foreseeable future. Other students, like myself, make a few extra bucks (or rather, earn back a pitiful fraction of our tuition) by helping out with research projects at the university.

I landed my gig by putting out a plea to the neurology department in general, and ended up working with a clinical researcher. In case you’re not familiar with the lingo, a clinical researcher is someone who is doing research with actual human patients, as opposed to bench research in a laboratory or chart reviews on a computer.

This was perfect for me, as I skipped out on a lot of bench lab skills by taking all my science courses in a single year. So for the summer, instead of having to learn how to pipet or stain slides or even look properly through a microscope (harder than you might imagine), I spent my days in professional dress and a white coat with a clipboard chasing down possible study subjects in a neurology clinic.

I actually helped with a couple of projects over the summer, but the one that counted as “my” project involved asking patients to fill out a long packet of surveys and collecting a urine sample. Simple enough, except for a few key points.

First of all, tracking down patients in a busy clinic is not an easy task for a wayward rising second year. No one quite knows where I fit into the usual hierarchy of things. On the one hand, I was attached to a particular attending, so my study had the weight of her position (and occasional presence) behind it. On the other hand, between the other attending physicians, the residents, the third year med students on rotation, the nurses and the general clinic staff, I rated somewhere below the janitor in terms of clout. (And let’s be honest, at least the janitor is directly useful on a day-to-day basis.) I spent a lot of time trying hard not to disrupt the goings on of the clinic, while somehow managing to get in everyone’s way.

I also ran into quite the snag when it came to paying for the urinalysis that was vital to our research. Even now I can’t explain exactly what was so complex about billing a six-dollar lab test to a readily available research fund, but suffice to say it involved my mentor making angry phone calls to administrators between patient visits, a brush with insurance fraud AND the possibility of several physicians not getting paid. For the record, none of that was my fault, but it was a stressful couple hours.

The urine samples also had to end up at the laboratory somehow. Usually this was a straightforward matter of leaving them in a cooler in the blood draw room, or calling for a pickup from a box in front of the building. Of course one day things didn’t go as planned and I found my samples sitting right where I left them after I returned from a nice, relaxing weekend. That was how I ended up wandering the parking lot of the research building, sample in one hand, keys in the other. “Just drop them off, directly,” my mentor told me. The glamorous life of the summer research student.

Ultimately my research involved a lot of waiting. Waiting for patients to show up for their appointments, waiting for them to finish filling out all of the surveys, waiting outside the bathroom for the tell-tale flush signaling a successfully obtained sample. I did a lot of reading. I chatted with the third year medical students doing their neurology rotations. I picked up tips from the occupational and physical therapists who came through. I learned a ton. But there is only so much expertise you can get through osmosis, and by the end of the summer I was ready to get back to the business of becoming a physician.

And our first unit now that we’ve returned? They changed things around a bit. Instead of starting with cardiology we’re jumping right into the urinary system.

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Light warning: While this post does not contain any of the explicit descriptions of dissection featured in the last two entries, it does, to borrow a phrase from This American Life, acknowledge the existence of cadavers and the events of anatomy lab. Also, my perception of acceptable dinnertime conversation remains off center, so please take that into account as you read this entry.

There is a special kind of fear struck into the hearts of medical students at the mention of the anatomical practical exam. Although this frustrating ritual of medical education has decreased in importance in recent years, it is still an important rite of passage for medical students. I call it a rite of passage because I question its direct vital importance to the learning of anatomy, despite feeling that the actual dissection of cadavers has been immensely helpful in my medical education. To be honest, I think the practical exam exists mostly as a means of motivating us to devote the proper time and attention to studying the cadavers, rather than being an accurate means of testing our mastery of anatomy.

At our school, the exams are held on a designated Friday afternoon. The class is divided up into groups, and each group (ranging from 30 to 50 students depending on the number of questions/stations available) is assigned a time. We are to

Seriously though, who even owns a clipboard these days?

bring a clipboard and a writing tool. Those who wish can change into scrubs, but no safety gear is required.

We arrive in the hallway in front of the lab, drop off our backpacks in the locker room, and stand around nervously. Eventually the anatomy professor emerges and hands us all pieces of paper with 60 blank lines. She instructs us to write nothing other than our names on the papers, but as soon as we enter the lab we can scribble whatever notes we wish. Once everyone is ready we file into the lab through the women’s locker room.

One of the lab instructors likes to spice things up. As we enter the lab there are jock jams blaring from an old boom box, and he’s wearing a bright orange baseball cap backwards as he jumps up and down. The man is in his late 50s at least, with a bushy white beard and an awkward, soft-spoken manner, so the first time I saw this I burst into nervous laughter. The other lab instructors and fourth-year TAs are also standing around in their scrubs and white coats, smiling encouragingly at our obvious anxiety.

We each head to a station. There are a number of cadavers, several models, and a number of computer screens with X-rays or CT images. Each cadaver has two stations, one on each side. Each station has a pin, an arrow or a string tied around a structure, and there is an index card nearby with a question or an instruction. There are several orange chairs positioned around the room as rest stations.

One of the professors gives us our instructions. They are the same every time: “Look at the number for your station and circle it. Be sure to write your first answer on that line. Don’t write your first answer on line one unless you are at station one. Check which number you are on frequently. You will have one minute at each station and there are a certain number of rest stations. Stay in order. Do not skip stations. If you get lost ask for help. If you do not know what structure is indicated, ask an instructor. If you ask anything else the answer will be, ‘use your best judgement.’” He says this last part with a sympathetic smile because he knows this is the most frustrating answer in the universe and the only way for the teachers to get through this exam in one piece.

Then he offers the usual advice: “First get oriented: are you on the front or the back? Which way is the head? Then identify the indicated structure. Next, read the card at your station and write the appropriate answer on the blank that corresponds to that station. Answer only the question on the card. Not all of the cards say ‘identify.’”

There are about eight televisions, the big boxy ones on metal shelves hanging from the ceiling like in public school classrooms. The screens are blue with a number in the center. When the instructor says go, the number starts at 59 and counts down silently to zero like you’re on a game show. Whenever the number hits zero, the lab instructor yells some variety of “rotate!” or “move!”

The instruction to “get oriented” seems obvious, but the cadavers are well draped. Mostly this is to protect them from drying out, a major problem, it turns out, once you remove a person’s skin. There is also a fair amount of obscuring done for the sake of difficulty. You cannot see faces, genitalia, hands or feet unless that structure is specifically being pointed out. The cadavers are also largely sans skin, so all the usual orientation clues are missing.

We are not allowed to touch anything either, which is frustrating given than all of our studying has required us to find the structures by digging them out for ourselves. If I’m used to locating the musculocutanous nerve by finding its origin at the brachial plexus, I had better hope they have positioned the cadaver so you can see the brachial plexus when they pin that nerve. It’s also harder to distinguish structures like arteries and nerves when you can’t feel to see if they are hollow or move the drape back just a bit to see if you can see what branches it gives off. I end up twisting and contorting myself trying to peer into body cavities without blocking the light, my nose and hair getting dangerously close to formaldehyde-soaked fabric.

One minute, as it turns out, is precisely enough time to settle on an immediate answer and then second guess yourself. In some ways it reminds me of physics tests from postbac, where it was better not to even try to check your work if you managed to stumble upon an answer. Just keep moving and don’t look back.

Spelling doesn’t count on these exams, which is good because the words ophthalmic and infundibulum will never cease to send my brain and fingers into spams without a spell check. We are strictly forbidden from abbreviations, however, which I find intriguing given how pervasive abbreviated language is in medicine and our school curriculum. (In two labs

Look at that judgmental expression. As if he could spell pterygopalatine fossa off the top if his head.

of brain anatomy alone we’ve already learned about PICA, and AICA, SCA, PCA, MCA and ACA.) They will also, apparently, take off for lack of specificity; it is the styloid process of the ulna, not the styloid of the ulna. There are also no points for being technically correct either; the identity of one x-ray structure was the adductor tubercle, and the fact that the arrow was also pointing to the medial condyle of the femur did not mean that was an acceptable answer.

Once the exam is over, we turn in our tests, file out, and, usually, head off to study for the written exam. By the time our tests are graded and accessible, we are usually well past the point of real concern. As good or as bad as it feels to see where you ultimately fall on the curve, the skills being tested in anatomy practicals don’t seem to correlate to anything particularly useful in medicine. “When am I ever going to have to diagnose someone without asking any questions or touching them?” one of my friends pointed out.

I will say, in defense of the anatomy practical, that studying for something “hands on” is completely different from studying for a written test. I could have pored over dozens of textbooks and memorized every division of every artery and nerve and never have really understood how it all fits together as well as I did studying it within a body. Some of my esteemed colleagues may disagree with me on this point, but I would argue that, although the exam may not have realistically assessed my understanding of anatomy, it was a powerful motivating force. I doubt that I would have ever learned so much or so thoroughly had that impending exam not driven me back to lab so many afternoons.

Warning: This is another graphic dissection-related post and possibly contains some of the grossest descriptions yet. I also might ruin oranges, cottage cheese and s’mores for you forever. Read at your own risk.

Do you know what you get when you send out an email asking medical students if they would like to give up an afternoon to assist with an optional brain removal dissection? A lab full of medical students wielding bone saws and chisels.

Where do we cut? The top part, right?

(If you’re already rethinking your commitment to reading this post, the back button should be at the upper lefthand corner of your screen.)

We’ve started our unit on the central nervous system, which means I am in full neuro-nerd mode. (Another student called me that earlier today and I like the alliteration so well I decided to keep it.) We’re not actually doing a lot of cutting in our dissections for this unit, but the brains did need to be retrieved from their usual location. The idea was to use all of the brains from our cadavers along with a few supplemental brains* from surgical pathology so that we won’t have to alternate dissection groups like we have been doing with our cadavers.

Here is how to remove a brain:

First you have to remove the skin of the cranium. You do this by making an incision from between the eyes to the back of the head and from one ear to the other and then peeling back the flaps. This was a bit more intimate than I was expecting, given that we had covered the face of our cadaver on the first day of lab and had not uncovered it since. The rest of his body was devoid of skin except for the soles of his feet and the backs of his hands. In many ways our cadaver had ceased to feel like something that had once been a person. Uncovering his face and making that first incision between his eyes was different. I have a hard time attaching an emotion to it–I didn’t find it sad or gross or creepy–but I noticed it.

Peeling the skin off the bone of the scalp is like peeling an orange. It comes away with a good solid tug and makes that same soft unsticking sound The deep fascia underneath even looks like the white inner rind. Underneath, the top of the skull looks just like every skull you’ve ever seen, off-white and smooth. The temporalis muscle on each side (the thing that tightens up at your temple when you clench your teeth) is the only non-boney landmark. We reflected them back as well so that we would only be sawing through bone.

The striker saws have small, semi-circular blades. They cut through the bone pretty easily, but they are just unwieldy enough that it’s hard to judge how deep you’re going. The goal is not to saw through the entire bone, but rather a few millimeters deep and then to crack the rest of the way through with a chisel and hammer. Halfway through this process you have to flip your cadaver over to make a complete circle around the head. Then you flip it onto its back and saw across the top like a headband.

The bone saws kick up a lot of bone dust and the friction creates a bit of smoke. It smelled to me like burning marshmallows. (No, I wasn’t hungry during this dissection, I swear! I reasoned it out with another student later: marshmallows and bones are both made of gelatin, after all.)

Some of the cadaver brains weren’t properly embalmed, which brought a whole new meaning to the phrase “my brain is mush.” They were the consistency of cottage cheese and oozed out of the new opening in the skull. Even the anatomy professor was grossed out. Those brains were left in their respective cadavers with several layers of wrapping around them both.

Our brain was well-preserved. The skull cap made a ripping/popping noise as it came free: the sound of the dura mater (the tough, protective coating of the brain) pulling free of the bone. Then we sawed through the occipital bone at the back of the head so that the spinal cord could be severed.

Even then, there was a lot more to be disconnected: the roots of the dura mater, the vessels that carry blood into the brain, all of the cranial nerves (there are twelve pairs.) Then we were done, and the brain came free like it was never all that attached in the first place. What, all that work just for me?

Strange to think that the object I was cradling carefully in two hands (not-dropping a brain on the first day was pretty high on my to-do list) had held all of the thoughts, the memories, most of the personality of the person it once belonged to. It is dead now, fixed and quiet, but I wonder if someday we might be able to look at all of the connections that existed and see something of the thoughts that passed through it once. Or maybe we’ll discover that to be something completely unknowable, something greater than the sum of its parts. It sort of hurts my own brain to contemplate. In a good way.

Ze Brain

*Every time I say the phrase “supplemental brain” I want to make a joke about borrowing one for the next exam. I know, it’s terrible, but I just can’t resist.

Warning: This post concerns my experiences in cadaver dissection. At this point in my medical training, I can casually chat about what went on in lab over dinner and not think anything of it. You, on the other hand, may have slightly conventional standards, and might find it a bit graphic. Please take that under advisement before continuing. 

Ready? Let's go.

Ready? Let’s go.

 

It’s a relief learning you are not the only person who finds skinning and separating out muscles on a cadaver oddly satisfying. It’s not really something you can bring up in polite company, but when a group of med students are sitting around the lunch table waiting nervously for their first practical exam, these sorts of things come up.

We’ve just finished our third week of lab and our cadavers are now largely sans skin. Removing it is a time-consuming process; skin and the fat underlying it are rather firmly fixed to the fascia and muscle below. The technique involves making two incisions to create a corner flap of skin, carefully going deeper layer by layer until you can see the red of the muscle or the silvery stripes of tendons. Then you grasp your flap (careful to not grasp any of the muscle tissue along with it) and pull back hard, like you could peel it right off. Then you scrape gently at the wisps of fascia between the fat and the skin with your scalpel, slowly detaching them and peeling away the skin. The idea is not to go so deep at to cut through the muscle and also to remove enough of the fat and fascia that you can see the muscles and structures below.

When it is going well it is not unlike managing to pull the entire peel of an orange in one piece. Or finally getting the long red piece in Tetris you’ve been waiting for the whole game.

When it isn’t going well, you can’t tell muscle from fascia from tendon from fat and you kind of want to start throwing your tools around the room.

Separating the muscles is similar, although you usually don’t even need a scalpel. You run your fingers or a probe through the fascia surrounding the muscle groups, pulling it apart like spiderwebs.

Nerves and arteries are more frustrating. They are usually bound up in a lot of fascia, but delicate enough that you want to avoid ripping through with your hands or slicing through with the scalpel. They also often look enough like bits of fascia (especially the smaller nerves) that you might not even notice them at first.

Going to lab has utterly revolutionized our schedule as medical students. Instead of spending four hours in a classroom listening to an array of lectures, we spend three or four hours on our feet, actively working through a lab. In some ways it’s a break for our brains; the concentration required to decide if you’re in a muscle or still on the plane above it is completely different than that required to memorize innervations or artery bifurcations. Most of the lab is physical work with breaks to try to identify structures. The time flies by and there is absolutely no risk of falling asleep.

We’re also divided into two groups per cadaver. One day my group might dissect the abdomen, the next day the other group will examine our work and dissect the front of the thigh. Which means a whole day off, at least once a week. After the non-stop slog of Monday through Friday 8 a.m. to 12 p.m. classes in the fall, this is like a dream come true.

That isn’t to say anatomy is a walk in the park. Some things in medical school are difficult simply by virtue of the fact that they require decades of experience to really master. Reading x-rays for example, or recognizing histology slides. I can memorize the nerve innervation for every muscle in the lower extremity, but learning to distinguish artery from nerve at a glance is an art. Sometimes even the professors aren’t quite sure what they’re looking at. This is the part of medicine that takes the most practice and is the hardest to explain how to do. It is also the part of medicine that feels the most like being a doctor.

I have been waiting to write about cadaver lab since I started this blog. It is such a defining piece of medical education and is surrounded by so much history and mythology that it is hard to imagine where the reality lies. Cutting open dead bodies is the stuff of horror films or indelicate humor. The idea that one body will become my template for understanding how humans work inside is creepy and exciting all at once. I am already intensely curious about the body I will be working on. Will it be a male or a female? How did she die? What kind of life did he  have? What made her decide to donate her body to us?

The school takes cadaver lab very seriously. We have several classes designed to address the implications behind dissection. At the end of the unit there is a memorial service for all the cadavers. We are warned to treat them like patients.

Our first assignment with the cadavers will be to wash and shave them. We have very specific step-by-step instructions on how to go about this. They are curiously impersonal and somewhat vague. For example, if your cadaver is lying face down you are to turn it over onto its back. And yet I have no practical idea of how one would efficiently go about this. There are certainly enough of us to manage the weight, but the logistics of arms and heads and the immediacy of lifting a dead body for the first time seem perilous.

If necessary, we are to trim and then shave the hair on the head, armpits and pubic region of our cadaver. I am interested as to how a group of nine people decides who is responsible for shaving the genitals of its cadaver. Certainly we are all going to have to get extremely familiar with uncomfortable areas of the body, but I will confess I am a little intimidated. I can’t even figure out if the fact that our cadaver is dead makes it better or worse.

I am excited to start anatomy in the same way I get excited at the top of a roller coaster. Part of me is thinking, “At last the thing I have been waiting for,” while the other part is thinking, “Um…maybe this wasn’t such a great idea.” I expect that, also like with roller coasters, I will be glad I did it in the end.

“The definition of insanity is doing the same thing over and over again and expecting a different result.”

You have probably heard that saying (or some version of it…I have a knack for butchering quotations) before. It usually applies to some part of a person’s life, although I’ve always felt that relationships were a particularly ripe arena for such behavior. We all have a friend, or are the sort ourselves, who fall for the same “type” over and over again and are continually bewildered when things don’t work out. Again. For exactly the same reason they didn’t work out the first ten times.

I’m realizing, as I dive into yet another unit of my education, that I have just such an insane relationship with medicine.

It goes like this:

I look ahead at the coming week, and inevitably I find something to get excited about. Perhaps we are going to be learning about cancer, or bacteria, or delve into pharmacology or the ethics of end-of-life care. It is medical school, so there is obviously going to be some medically related theme, and I, it turns out, am a sucker for wanting to know about medicine. (No big surprise there, otherwise there are a lot of questions you might be asking about how I ended up here in the first place.)

I get excited. And I make plans for how amazingly well I am going to study this subject and how intricately I am going to learn all of the details. And then the week begins.

The trouble is, medical school is hard. Just as surely as I will get excited about what we are to be learning, I will also hit a wall where I just don’t know that I can learn it all. Sometimes the concepts are complex. Often it is just the sheer amount of material piling up before me; lists of microbes and drugs and pathways that I swear are more numerous than neurons of the human brain. No matter how much I want to know the information or how interested I was the weekend before, no matter how convinced I was that this week was going to be different, I am overwhelmed and quite sure I will never learn it all.

Eventually the week comes to an end, often bringing with it some sort of assessment, and seemingly by the skin of my teeth and a bit of luck, I manage to do pretty okay. I curse myself because, well I’m perfectionist and even in a pass/fail system doing pretty okay makes me nervous. I tell myself that next time I am going to nail the material into my brain so hard I will carry it to the grave.

I look at the next week’s material. We’re learning about viruses.

I love viruses.

Seriously, how weird is this thing?
Source: Wikipedia

It’s been awhile since I’ve done a science/medicine post, but this one caught my eye the other day. One of the things I find fascinating in a creepy way about the body is how much our personality is controlled by simple chemical reactions. Entire personalities can change as a result of damage to the brain or a change in neurotransmitter and hormone levels.

source: Re-Create Your Life Today

Oxytocin is a hormone produced by the posterior pituitary in the brain. It is responsible for uterine contractions when a woman gives birth. It is also the hormone that is associated with that warm fuzzy feeling we feel when we are close to someone we care about. It is produced during childbirth and during sex. It is often called the “love hormone” because much of the non-sexual attachment we feel for our offspring and for our significant other are attributed to oxytocin. (I also would guess it’s produced when I see fuzzy, baby animals, because something chemical has to be the reason my voice raises two octaves every time my roommate’s dog enters the room.)

Also, as the article that caught my attention points out, oxytocin might be an important determining factor in our moral decision making.

It makes sense; if oxytocin makes you feel kindly toward others it would make sense that your choices would be more aimed at the good of the whole.

But I balk a little at this term “moral.” The article seems to equate trust and generosity is a sense of morality, and even makes the point that hormones known for increasing self-preservation (testosterone in this case) counteract the effects of oxytocin. A bride, feeling warm and loved in the thrill of her wedding experiences a much higher jump in oxytocin than the groom, whose testosterone levels shoot up as the guests admire her in her wedding gown. (Or so the author conjectures.)

Generosity isn’t a bad way to measure moral fiber, I suppose, but donating money a pretty unambiguous measurement. What about the more complex moral choices we make every day? The article left me wondering; do oxytocin levels affect a woman’s choice to keep or abort a pregnancy? What about race, religious tolerance or homophobia? And does this battle with testosterone imply that morality and self-preservation are inherently at odds? Certainly the act of falling in love and out of love can have a detrimental affect on our reasoning skills.

The author does take this into account and points out that there are myriad factors besides oxytocin playing a part. But as food for thought, it certainly has my wheels turning.

It’s probably not the sort of thing one says in polite company, but I really like doing dissections in biology lab. It brings out the little kid in me, that part that loves to take things apart and see how they work, that finds the squishy insides of the animal to be both totally gross and totally fascinating at the same time.

The first dissection I did was in high school freshman biology. We studied frog anatomy, and the day before the dissection we were charged with observing “external characteristics.” This basically meant that right before we sliced into our specimens, we were given an entire lab period to bond with our frogs. One of my friends couldn’t take it and spirited her frog away by stashing it in the front pocket of her backpack. We released him into the creek behind the school; I have no idea if the environment there was at all suitable.

I expected to have a real problem with the actual dissection. It just didn’t seem like something I should enjoy. The frogs had their brains (literally) scrambled beforehand, meaning that their hearts were still beating when we opened them up. My group was made up of two other girls, both very tentative about the whole process, so I ended up taking charge somewhat against my will. I remember cutting my frog open very carefully and watching his heart beat inside of his spread rib cage. I was amazed. I knew that hearts beat, but I had never envisioned how violent it was; this ball of muscle twisting and writhing just behind a few layers of muscle and bone.

Since then I’ve always claimed to love dissections, and couldn’t wait to start cutting. We worked our way up slowly; first an earthworm, then a crayfish and an enormous cricket, then a squid and a clam. Of course the day we started on the fetal pig, which I had been looking forward to since we first went over the syllabus, I was in the midst of my aforementioned plague and spent most of the lab feeling nauseous from the stench of formaldehyde and trying not to cough on our specimen. It probably didn’t help that we were looking at the digestive system, which, even in a fetal pig, involves a lot of organs filled with fluids you would rather not contemplate too closely.

This week we tackled the circulatory and respiratory systems. Having moved out of the gunkier areas of the body and feeling more energetic, I recalled why I loved dissections so much. The heart lay in the center of the pig’s chest, shiny and strong; not beating in this case, but impressive nonetheless. The lungs weren’t fully formed, but it was easy to  see each individual lobe as it curled almost protectively around the heart. Ironically one of the things that gave me the biggest thrill was pulling back the connective tissue around the trachea and larynx; I was stupidly suprised to find that they looked just like the pictures.

Looking inside a living organism, particularly one as similar to humans as a fetal pig, feels special to me. I always imagine that pictures and diagrams are simplistic; a rough estimate representing a non-existent every-man. It surprises me to realize that it all actually looks like that when you get inside. The liver really is smooth and rounded, the aorta really does loop up over the top of the heart, the trachea really does look like rings stacked on top of one another. It’s a cliche, but inside we really aren’t so different after all.

We have one more biology lab before we’re done (I think a sheep’s brain might be involved). I’m not going to miss it exactly, but I will say that I’m not dreading cadaver lab in med school one bit.

I’m drowning in organic chemistry and lab reports right now, so this week’s post is both late and brief. But it’s about viruses, and there seems to be a biology-classes consensus that viruses are way cool. Not only that, but this virus is one that attacks other viruses. Is it a force for good? For evil? For nerds? Who knows? Regardless, this discovery of the Organic Lake Virophage (OLV) makes for three total virus-eating viruses that have been discovered to date. Pretty neat.

I’ve feared it, I’ve bemoaned it, I’ve ignored it — but the time has finally come. I’m going to start studying for the MCAT.

MCAT, for anyone who might not have been obsessing about this for the past six months, stands for Medical College Admissions Test. It is required for admission into every reputable medical school in the U.S. In an age where the GREs and the SATs are increasingly disparaged as in inaccurate measure of intelligence and are slowly disappearing from undergraduate and graduate applications, the MCAT exam continues to haunt the dreams of pre-meds nationwide.

There are four parts to the exam; biological sciences, which include biology and organic chemistry, physical sciences, physics and inorganic chemistry, a verbal section similar to the SATs or GREs, and a writing section that is graded separately on a bizarre scale of J-T. Each of the other sections is scored out of 15 points, for a total of 45. As far as I’m aware the maximum score is mythical; most students who get into medical school score in the 30s. One former postbac scored a 42 a few years ago and it’s still spoken of with a reverent tone.

I’ve never been much of a fan of standardized tests. I barely slept the night before I took the national exam for massage therapy, and that was pass/fail. The MCAT is like the mother of all final exams; the anxiety of every chemistry, organic, physics and bio test combined with a splash of fear that my verbal skills will desert me in my time of need. Let me put it to you this way; if I were offered instead to be jabbed with hot pokers for the four hours of the exam and be assured a reasonable score I’d probably do it.

Since the start of the program, the MCAT has existed in the back of my mind as a vague worry, but the full-fledged fear didn’t kick in until we were sent home with our study guides right before winter break. You know those three hundred page paperback SAT/LSAT/GRE study guides? That’s what I was expecting. Instead I was sent home clutching a four-book boxed set; the kind that comes in a cardboard case so you can keep them all together and then wrapped in plastic so none of the volumes can slip out.

The moment I returned to my apartment the study guide went up onto my bookshelf and remained there, untouched, for the duration of break and the start of semester. Other students talked about peeling the plastic wrapping off or starting in on a section or two; my study guide and I just eyed each other distrustingly as we went about our business.

Sadly, though, my days of obliviousness had to come to an end. Spring break arrived and with it the last of obstinacy. Before leaving on break I steeled myself and ripped the plastic from the cardboard case. Figuring my course load would be enough to keep most subjects fresh in my mind, I extracted the chemistry and the verbal reasoning volumes and slipped them into my backpack beside lab manuals and textbooks.

It’s strange; going into the postbac I felt as though I were signing my life away. Even though I knew it was just the first step on a much longer journey, I didn’t really consider the fact that it would someday be over. Now I’m two months away from the end. Terrifying as studying for the MCAT may be, it’s exhilarating to realize how much closer to my goal I’ve become.