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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.

From my notes:

Disease (objective): the organic pathology that afflicts the patient

Illness (subjective): the psychosocial experience and meaning of perceived illness

Taking a thorough patient history is one of the fundamentals of medicine we are being taught as future doctors. For reference, I mean sitting down with patients and interviewing them for a good 15 minutes to a half-hour in an attempt to elicit every facet of their illness and general lifestyle. A good history includes not only every conceivable detail of the progression of the current illness and past medical events, but also the history of any family illnesses and every social habit from alcohol use to religious affiliation to sexual habits. And then to top it off, a review of the body from head to toe, looking for anything out of the ordinary. Ideally all of this occurs before the doctor orders a single test  or begins any sort of physical examination.

The point of a thorough history is to take into account anything that might be relevant in treating the patient. We’ve had sample cases where the key to the whole diagnosis was asking a single, specific question, like whether they have travelled recently or what herbal supplements they might be taking. In other cases, the point has been to highlight socioeconomic factors that might affect treatment, like inability to pay for medication or an abusive relationship. Even when asking questions about the current illness, the most innocuous-seeming details, like when pain or fever is most acute, can hold vital clues.

As we practice which questions to ask, we are also learning how to ask them. We’ve had long discussions about how to phrase certain inquiries (how should you initiate questions about a patient’s sex life?) or how to react to difficult patients (angry, seductive, anxious.) We do some of this  through role playing in small groups or with standardized patients. We hear about some in general terms in large lectures. A few times, they’ve sent us up onto the wards to talk to real hospitalized patients.

It’s harder than it looks. You end up wearing a lot of different hats as you go through the interview. Part of you is frantically sorting through differential diagnoses, trying to make sure you don’t miss any question that might rule something in or out, while another part is trying to listen and react appropriately and empathetically. Meanwhile, you’re attempting to scribble down all the relevant details so that you can give a coherent and comprehensive presentation at the end. You’re also trying to incorporate the volumes of feedback you’ve received from previous attempts, words and phrases to avoid, and questions to remember.

Pictured: medical students practicing interviewing skills

We medical students are like newborn puppies, constantly tripping over ourselves, ending up in a cringeworthy heap. The first time I practiced a sex interview I turned confidently to the student sitting next to me and asked, “Do you have men with sex women or both?” Trying to elicit a family health history from a hospitalized patient, one of my partners jumped in with, “I would assume your parents are dead by now, right?” (Fortunately the subject of the interview and her children, who were still in the room, found this hilarious.)

In the real world, a full patient history is rarely taken by sitting down with a physician for a block of time. Most primary care doctors just plain don’t have enough time. . They usually gather information piecemeal through intake forms filled out by the patient, follow-up questions from the nurse, and whatever they can tease out in a visit. Also these days a lot of medical care is provided by specialists who may have a narrower view of the potential problem or who may be working off information gathered by a referring physician. Of course, there are other times when a full history just isn’t practical, like in emergent situations when stabilization is priority one.

I wanted to write a bit about taking a medical history because illness is complicated and often involves a great deal more than just the most obvious symptoms. Although explicitly the message is that any detail might be vital, the real lesson is that every detail is relevant. And I think it is important for both patients and doctors to realize that. I hope the fact that our medical education emphasizes this so much means good things for the next generation, my generation of physicians.

Since starting medical school, I have been harboring a not-so-secret resentment towards the simplicity of men’s professional clothing. Button-up shirt and a tie, slacks, dress shoes, white coat and you’re done. Sure, there are variations on a theme and I’m sure there are men out there who put a lot of thought and care into their outfits, but even if you’re just falling on the basics it’s hard to go too wrong.

I don’t know anything about this dude, but I already trust him to save my life or take all my money.

It’s not that I don’t like getting dressed up. We had med school prom last weekend (I know, right?) and picking out a dress and accessories was an enjoyable distraction from academics. But that’s the thing about women’s fashion: it’s fun because it’s complicated. There are choices to be made, and choices mean a certain level of success and failure. Great for a night out when you want to make an impression. A pain in the neck when you’re running on four hours of sleep with an exam hanging over your head.

Let’s start from the ground and work our way up. Flats or heels? And if you go for heels, how high is appropriate and comfortable to walk around in? When and where are open-toes, open heels or sandals acceptable? Socks? Stockings? Tights? Bare legs? Dress, skirt or pants? And how short a skirt is acceptable? How tight a skirt is acceptable? How loose and flowing a skirt is acceptable? How large a belt? Is your skirt see-through? Is your shirt see-through? If it is, as is the case with most women’s clothing, what sort of undershirt should you wear?  Is it too low cut? Should you wear any jewelry? How much make-up?

The answer to any of these questions varies drastically depending on the person you ask. If you get it wrong there can be serious consequences. I’ve already written about the trials of wearing the wrong shoes, but there can also be more subtle types of pitfalls. For example, studies show that wearing exactly the right amount of make-up will help a women be taken seriously in interviews, but too much or too little will leave a negative impression.

There is this fine line between being attractive, but not too attractive. There can be absolutely no sign that you are attempting to look sexy, but it can be equally damaging to be perceived as “mannish” or plain. There are few solid rules to follow; the fabric of a shirt or the shape of the woman wearing it can push either extreme. And because of the subjective nature of these judgements, you may never know when or how you transgressed.

Clothing stores and designers are not helping either. There is no clear delineation between the different tiers of professionalism and fun dress when you walk into a department store. Watch any television show and the going standard for professionals seems to be six-inch stilettos and a carefully calculated cleavage-to-neckline ratio that defies most Newtonian laws of physics.

At least the skirt covers her knees?

I don’t mean to imply that all of the women in our class are walking a razor’s edge every time we’re expected to look professional for a patient. Still, it does take time and energy and attention to detail that I don’t expect the guys in our class experience in the same way. It is also starting to get expensive, not only because women’s clothes tend to be pricy but also because each outfit is distinct enough that repeats are noticeable even to the less observant. I’m sure the boys all change up their clothes regularly, but I’m paying pretty close attention if I even spot a repeat tie pattern.

Of course much of this stems from larger, systemic issues regarding the treatment of women in the workplace and the double standards we set for professional behavior. I could go on for days. In the end, though, I wish we could dispense with the whole mess and just all wear scrubs to work every day. How can you go wrong?

Okay, fair enough.

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.

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Okay, so this isn’t a blood draw needle, but you get the idea.

I’m thinking of creating a version of the Who Said It game called “Medical Students or Burgeoning Serial Killers?” Here are some approximate quotes I’ve collected over the past several months.

  1. “I’ll just keep all of the blood vials in this basket here until I can figure out how to dispose of them.”
  2. “Skinning a human cadaver is harder than I expected.”
  3. “We should get some pig’s feet to practice on. It’s more like human flesh.”
  4. “He gets all the supplies by telling the clinic staff we’re planning to practice blood draws.”

Okay, since I don’t actually know any serial killers in training (I hope),  the game is pretty one-sided for now.

For a bit more context (lest you think perhaps a quick call to the FBI might be in order), this week marked our foray into cadaver dissection, and also the third so-called phlebotomy party.

The phlebotomy parties came about around Thanksgiving after a primary care conference where students were able to practice skills like suturing and blood draws. I wasn’t there, but from what I heard, many of the blood draws were not terribly successful.

I don’t know about my fellow students, but practical skills in medicine make me nervous. I know that I can memorize pages of information and answer multiple choice questions with reasonable accuracy, but none of that guarantees I will be any good at basic medical skills like lumbar punctures or taking blood pressures. The latter I can practice whenever, at least. Mostly of my family and friends have been subjected to me brandishing my stethoscope and sphygmomanometer. But the stuff involving needles? At best you might get to practice them on a dummy, which is really not going to prepare you for a terrified patient, angry at being used as a training tool.

Blood draws, at least, are fairly straightforward. So with a few donations from a local clinic, one of my small-group classmates with some phlebotomy training gathered together everything we might need and had six of us over for dinner and bloodletting. After all, if you’re going to mess up poking someone with a needle, it might as well be someone who is planning to stick you right back.

The first stick is, in a word, terrifying. There was this moment before I slid the needle in that I was thinking to myself, “I can’t do this. How could I ever think that I could do this?” Then bam, a minute later I was triumphantly holding a full vial of blood, my heart pounding in my chest and a general feeling of “Holy crap, I can’t believe I just did that.” Then I turned around and offered my own arm up for some first-time needle sticking.

Our first session was such a success that the host has had two more since. They are well-attended and it is a relief to watch everyone go through the same spectrum of emotions each time: terror, followed by determination, and then elation at their eventual success. We can do this! It’s for real.

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Uh…now what do we do with it?

A friend of mine pointed out that as physicians we probably won’t be taking a lot of blood. That is more the purview of nurses and techs, even if we will eventually learn the skill. Still, it is a relief just to know that I can handle the basics. For the first time I was able get past the literal barrier of the skin, into the parts of a living person that we generally never see. I don’t expect this will make me less terrified or apologetic when I finally do have to practice on a stranger for the first time. But at least now I don’t have to wonder if I am even capable.

And, even if it’s only the barest of comforts, at least I can say, “I’m new to this, but I’ve done it successfully a few times before.”

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.

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.

I never intended for my work at Planned Parenthood to become so central to this blog, but in light of a lot of recent controversy I wanted to add some facts to the discussion.

You see, I was confused when all of this talk began about the government mandating a transvaginal ultrasound prior to an abortion. I was confused because for the past year and a half I had been checking the box marked “Ultrasound for pregnancy dating” on the list of procedures my counseling patients had gone through. I had watched patients waiting to empty their bladders before having the ultrasound (because that is necessary for a clear image.) I even had one patient shudderingly tell me how she had invited her husband in, expecting the more tradition ultrasound, only to have to tell him to close his eyes when the wand was inserted.

The clinic has been doing two transvaginal ultrasounds as a matter of course; once prior to the abortion and once at the two week follow-up to make sure the contents of the uterus had been removed successfully. They have not been doing this out of malice or a desire to sway their patients toward keeping the pregnancy. They were doing it because the doctors who worked at the clinic felt that it was medically necessary.

Why? Two reasons. First to make sure that the patient is actually pregnant. If she is not far enough along that the image can be seen on the ultrasound, the patient might be giving a false positive pregnancy test. Performing an abortion on a woman who is not actually pregnant would be the textbook definition of medically unnecessary.

The doctor also has to make sure the pregnancy isn’t too far along so as to violate the parameters on when an abortion is legal. It also lets the doctor know if the pregnancy is nearing that limit. Women going on 12 or 13 weeks are given an extra medication prior the surgery to make things go more easily. Women opting for the medical abortion (the abortion pill) have an earlier cutoff point. Dating the pregnancy gives important information to the physician.

A transvaginal ultrasound is not the only means of dating a pregnancy. A manual exam can give an accurate timeline as well. This is also an invasive procedure, but doesn’t require use of the ultrasound wand or result in an image of the fetus.

This is where it gets tricky. The question of “medically necessary” varies from physician to physician. The doctors I work with think that it is necessary. Another physician may find the manual exam adequate. It is a medical decision, and as much as we would like to believe those are universal, they are not always clear cut.

But they are medical decisions, not legal ones. That is why we should be angry about the attempt to pass these laws. No politician, particularly one who believes abortion to be immoral, has taken the time to research and understand the nuances of a decision like that. I can’t even decide, and I have watched the abortion procedure and explained it to patients in great detail on a weekly basis. There is no comparable law on the books that dictates a medical decision in such a way.

The issue here is physician autonomy as it relates to women’s rights. It’s an important issue, I won’t deny it.

On the other hand, it frustrates me to no end to have this procedure compared to rape. This is a legitimate medical process that provides valuable information necessary to a successful medical procedure. The doctors who choose to perform transvaginal ultrasounds are not raping their patients and to imply that for the sake of demonizing the opposing side is damaging and hyperbolic. It’s not a lot of fun, but it is far from the emotionally scarring, physically traumatizing experience of being forced to engage in sexual intercourse. A woman undergoing a surgical abortion will be penetrated whether or not she has a transvaginal ultrasound. That is how a surgical abortion works. That is her choice. Remember? That’s what we’re fighting to hang onto here.

The other choice is that of the physician. He or she deserves to have the power over that decision, not a congressman with a soundbite to sell.

I hate it when Planned Parenthood is called an “abortion factory,” or when the wonderful people who work there are accused of pressuring women into the procedure. I hate it because it isn’t true and it isn’t fair. I don’t want to play that game. The fact is that the attempted government mandate would dictate the actions of physicians in a way that no other medical procedure would tolerate. The fact is that the individuals behind the mandate are not qualified to override doctors’ medical opinions.

But rape is rape. A transvaginal ultrasound is not.

Illustrations in textbooks can easily go unnoticed, but that doesn’t mean a great deal of thought and detail hadn’t gone into their creation. Occasionally a detail will stand out in a way that makes you remember that there was an actual artist on the other end of image’s existence. I remember in my biology textbook the artist would use this blurring effect to indicate motion, implying that the enzymes involved in DNA replication were just whizzing along like streetcars on a rail.

This video shows the making of a medical illustration. I found it interesting the type of prep work that goes into creating the image. It seems obvious, but I never really thought about how the illustrator would become familiar with the structures, particularly in a more advanced text like the one used as example (neurosurgery.) Certainly the artist doesn’t need an MD, but they should have enough of an understanding of the process to highlight the important pieces of the process.

Which makes me wonder if there aren’t doctor-illustrators out there. There are enough doctor writers, and the textbooks themselves are written by experts. It seems like it would be helpful to have an artist with a medical background, someone who would know from experience which details to include and which are distracting.

As I’ve said a few times in the past, deciding to do the postbac was probably one of the most difficult choices I’ve ever made in my life. Any decision that reverses the expected course of your life goals should take some careful consideration, but even more difficult for me was the idea that I was committing myself to a very challenging new path. There were real questions about the validity of my interest and abilities, the answers to which, at the time, I could only guess at.

It all turned out remarkably well, and, even though my success in medicine is far from set, I feel pretty confident in saying that the postbac was the right choice for me.

Making that choice was a leap of faith, but there were certainly promising signs that I was on the right track. So for anyone out there who might be considering applying for postbac programs, here are some signs it might be the right choice for you.

 1. You can’t stop thinking about it.

Before I even knew what a postbac program was, one of my acquaintances (I can’t even call him a friend; we have been out of touch practically since this conversation took place) called me on one of my passive comments about an interest in medicine. He showed me an alternate viable route toward becoming a physician. I laughed it off at the time and gave him a dozen excuses for why I couldn’t go back to school and why it was too late for me to be a doctor. But the seed was planted.

It haunted me. For weeks it followed me around, popping up at work, in the grocery store, walking past the hospital. I happened to live across the street from a medical school at the time, and I would watch the students and residents walking to work in their scrubs, feeling quietly jealous. I kept returning to the website my acquaintance had referred me to and calculating the time, the cost, the sacrifices that would be involved. Finally I had to admit it to myself: if this idea was so seductive it could bleed into every aspect of my life then clearly it was an idea that needed to be addressed directly.

 2. When you weigh your priorities in life, a career comes out on top.

I have always believed that the key to my happiness lay in finding a career in which I could become immersed. I have a bit of an addictive, obsessive personality. It isn’t necessarily a healthy approach to life, but it is a consistent one. Medicine requires a huge commitment of time, money and energy. Whenever I thought about the things that were important to me, though, having a career that inspired me was always the most important.

This is not always a clearcut choice. Personally I have never been attached to the idea of owning a home, raising a family. Getting married sounds like a lovely idea in abstract, but it has never been a goal for me. That isn’t to say that physicians, even those going into the field later in life, can’t have families or houses, but it is more complicated. You will often have to choose between work and everything else in life. If that is going to be a struggle every time, there might be a better option in the medical field. Which leads me to my last point….

 3. Nothing else will do.

There are a lot of different careers in medicine: EMT, paramedic, nurse practitioner, nurse anesthetist, physician’s assistant, all sorts of technician jobs. The list goes on forever. Many of these jobs are more conducive to raising a family or staying out of debt. A lot of them allow for nearly the same level of autonomy as a physician.

At one point, when trying to sort out exactly how I would put myself through school, I became fed up and thought about giving up the notion of becoming a doctor. I weighed the option of becoming a physical therapist or going to nursing school. No sooner than I had the thought than I felt crushingly depressed about the idea. It wasn’t the same. It wasn’t just about wanting to be involved in medicine, it was also about challenging myself, about seeing exactly what I could accomplish if I pushed myself to my limit. No other path filled me with excitement or hope like the prospect of becoming a physician. I couldn’t shake it, no matter how impractical the notion.

For the record, these are all my personal experiences. I don’t think they are typical, nor would I say that without them going into medicine is a bad idea. But I do think that the choice to be a physician is a serious one that should take careful consideration. You’re in it for the long haul. If the passion isn’t there, it’s going to seem a hell of a lot longer.