June 2017



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Things I have accomplished this weekend:

Two loads in the dishwasher and handwashed the rest. Thus went from no clean spoons to all clean spoons.
Made beans and 2 kinds of lentils, from dried, towards veggie chili later this week
Made peanut-sesame sauce towards noodles with peanut-sesame sauce later this week
It wasn't today but I'm putting it here because I'm so proud: made chicken broth from actual chicken! towards later meals, this week or otherwise.
Made honey-peanutbutter balls, you know, the ones with dry milk you made in preschool. For as long as they last.
Changed pharmacies and refilled expired inhalers
Put every medication I need to know for next Friday's exam onto a spreadsheet. N=89, which is actually less than usual, and includes some non-medication methods of contraception
Reviewed 40 pages of notes on skin diseases for Friday's exam.
Got tendonitis

Things I should have accomplished this weekend (some of which I still do need to accomplish by bedtime!):

Reviewed the rest of the 39 pages of notes on skin diseases for Friday's exam (so I can then start reviewing 124 pages of musculoskeletal notes and 139 pages of reproductive notes, plus also read some in the textbook)
Found (OK, looked for - I know where it must be) my power bill so I can pay my rent
E-mailed prof about learning to draw blood
E-mailed Library Person I don't know about my using her models to practice clinical skills
E-mailed IT person about computers in the hospital
Figured out who to talk to about where I'm doing psychiatry for next year
Figured out if the course coordinator for OB next year has changed, and if so, if this affects me in any way.
Remembered it was Mother's Day. (I really thought it was the third Sunday in May)
Done laundry (sock count = 3 pair knee socks plus innumerable ankle socks.)

Well then.

Back to the salt mines?

Physics majors, prepare to laugh. Or cover your ears. Or something.

I only understood two weeks of my high school physics course. Oh, I did fine in physics. I did fine in all my high school classes. But there were really only two weeks when I felt comfortable with the material, felt as though I had a sense of what was going on.

Those were the week we studied sound, and the week we studied light. Well, I had played the violin (badly) for much of my childhood, and I had a pretty good intuitive idea about waves traveling along strings, waves of sound traveling through the air. I knew that my favorite A, the one I heard the Boston Symphony using to tune up, it was at 440 Hz. And when I say light, I don't mean wave-particle duality, and fiberoptics and all that, but the basics about colours, wavelengths, mixing, focusing. And, well, I was a techie and a pretty good hand with a Rosco gel book. I knew how to move the lenses around to make a sharp or diffuse spot of light. And, well, I wore eyeglasses, too. Relevance, right on the bridge of my nose. Suddenly, for two weeks in the spring of my senior year of high school, physics made sense.

For the rest of the year, I pushed numbers around and took a great deal on faith. For, the rest of the year, physics seemed to call upon an innate sense of the world around us, a sense which I alone did not seem to share. I knew I was in for trouble from Day One, when I came home with my first assignment to sharpen our skills of estimation: how many McDonald's Hamburgers would fill Fenway Park.

Fenway Park. That's the baseball one, right?

Everyone else in my class was a baseball fan to some degree, the twelve boys and the four other girls. I had been to one baseball game, nearly ten years previously. Oh, and its not as though I had ever seen a McDonald's Hamburger at close range, either. I begged my father, baseball aficionado, sometime hamburger eater, and former chemistry major for some help.

Most of physics was like that. Oh, I learned Newton's Laws, and where to find the numbers to plug into the related equations. I dropped hypothetical objects off cliffs and rammed theoretical pool balls into each other, and crunched the numbers with the best of them. But there was this constant undercurrent to the class, like I was missing something.

The biggest thing I was missing, actually, was not knowing how to drive a car. I wasn't ready to drive at that point, and had made the mistake of saying so. This had long been a point of ridicule outside the classroom. And it had come up from time to time within the classroom as well, such as the day in French class we were learning to express wishes. We went around the table, reading our sentences aloud. With one notable exception - me - the wish of every tenth grader was to get a learner's permit, that of every eleventh grader was to obtain a driver's license, and that of each senior was to own a car. But this was different. In French, the car talk had been self-generated, internal. My learning didn't depend on what my classmates did or did not drive. This was external.

"You know how when you're driving, and you go around a turn [speed up, stop short], you feel. . . ?"

Sixteen eager nods. One blank look. I didn't notice these things when riding, either. After I had them pointed out to me, accompanied by the appropriate physics equations, I did notice. Sometimes. But as we flitted from cars to baseballs, I never lost this nagging feeling like I was missing the whole point, the whole innate sense of - well, of everything.

Why am I rehashing all this now? Isn't physics over and done with? Well, yes, thankfully. I never have to grapple with the intro physics curriculum again. Thrice is enough. It's coming to mind again because I am having the same sort of reaction to this Immunology book I'm supposed to read this summer.

It's called "How the Immune System Works." And it is a very good thing that I already have a pretty good idea how the immune system does work, thanks to an excellent professor I had at Haverford way back when. Because this book, in addition to cheesy diagrams and some (to me) disturbingly flip comments, relys on a whole series of analogies and comparisons and models.

Turns out I don't know anything about football.

I understand cytotoxic T lymphocytes, and the two subclasses of T helper cells, but explanations of which ones are like the quarterback are simply lost on me. And, while I still understand T cells, I have gained no further insight about the function or role of a quarterback. And I resent the assumption it makes, that immunology is difficult but football is easy, familiar. Because not only have I had immunology before, but I don't recall it being too hard the first time.

It's a real dilemma when one is teaching, when to rely on students' outside knowledge.
I had it easy, of course. Yes, I am arguing that, in my school of students with severe ADD, children who had not succeeded in other settings, I had it easy. And in this respect, I did. Well, I knew my kids, for one, and I knew what models I had to refer to within their own lives. I knew that I could put Gregor Mendel in context for them by explaining that gardening was his "chore" at the monastery. (An Austrian monastery, incidentally.) We all understood chores. When my students were building bookshelves with another faculty while studying DNA with me, I explained how a chromosome is like a book of "How-to" instructions, RNA is like a photocopy from one chapter of the book, and the bookcase is like the finished protein. The kids thought I was nuts, yes, but the analogy was relevant to their shared experiences, it stuck, and they learned.

We also had the luxury of a small-group learning environment. If I wasn't getting through to one or more of my students, I could see that instantly and either try again or change techniques. I could explain the same material five different ways for five different students. We also had the luxury of time. If it took an extra week or so to learn a topic correctly, well, then we used that additional week. How much harder it is to address a class of 25, or 50 or, dare I say it? 240 unique learners. And how much harder it is when the schedule is set in stone, or the registrar's office, which is pretty much the same thing, really. And harder still must it be to write a textbook, where even the second-chance of office hours has been removed from the realm of possibility. How tempting it is, then, to make broad, sweeping assumptions in the hopes of reaching almost everyone, most of the time.

In medical school, since we all had to take the same pre-med courses, there are certain safe assumptions. We all took general and organic chemistry, and introductory physics so we could have the privledge of being here, although whether or not we remember any of that material is open for debate. In Anatomy, it was safe to assume we all come with more or less the same body plan for reference. During an exam, it is amusing to glance about the room and see someone flex an arm and another pat a leg, checking on muscles with the only model permitted in the exam setting.

I will gladly learn the anatomy, the biochemistry, the immunology, the pathology. Some of it may come easy, and some of it may be a struggle, but it is the reason I am here. But, no where in the job description of doctor, or even in those dreaded "technical standards" lists, does it say that I have to master the art of football, too.

Football. That's the one derived from Rugby, right? I think I saw a game of that, once. They threw toast.

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