One unintended consequence of medical school (and becoming a doctor) is now apparent--everyone assumes you should know everything there is to know about the human body. Hell, I've only read biochemistry for an online class and I had to defend my right not to know an answer to a question from my roommate:
Roommate: Why are you supposed to work out in the morning?
Me (bullshitting): Hmm. Maybe because your glycogen levels are high in the early morning, so your body will be forced to use its fat reserves first?
Roommate: Really? Because I would think that...
Me: Okay, okay, I have no idea.
Roommate: Shouldn't you know that? Aren't you gonna be a doctor?
Me: I don't know! I'm not a dietician!
But I'm guilty of it, too. I've said the exact same thing to my dad (a psychiatrist) on numerous occasions.
Me (pubescent teenager): Dad, why does it hurt when I go like this?
Dad: I don't know. Don't go like that.
Me (scathing, bratty, "God, my parents are so dumb"): Shouldn't you know that? Aren't you a doctor?
So now the tables are turned. But the thing is, I kinda feel like, "Yeah, I should know that," although I don't understand things well enough yet to integrate all my knowledge. I mean, yeah, I guess I'm supposed to know everything, but... everything? That's... kind of a lot.
Props to the placenta. If you remember your Health 101 course from high school, the placenta allows woman and fetus to share nutrients, immune cells, and even oxygen without sharing the same blood. (It also can make almost every hormone the rest of the body's organs can make, but that's for another day.) Oxygen floats around your blood inside a molecule called hemoglobin (one part of the hemoglobin molecule complex contains iron, which is what makes your blood red). But how does the oxygen get transfered from one blood system to the other? Simple. As the woman's hemoglobin starts to dump off her oxygen, the fetus's hemoglobin scoops it up.
Take a look at the graph to the right. (Don't run away! Please!) On the Y-axis, you've got hemoglobin O2 saturation (ie: the percentage of hemoglobins that are still carrying oxygen, and haven't released it yet). On the X-axis, you've got the pressure of oxygen in your blood (ie: how much oxygen's in your blood at a certain spot in your body - it decreases the further you get from the heart). Now take a look at the blue line--that's the adult line. At 40% pressure, about half of the hemoglobins still have their oxygen. But as you get further from the heart, hemoglobins start dumping their oxygens more rapidly.
Now look at the fetal, red line. It's above the blue one. So, at the same pressure, more of the fetal hemoglobin still has its oxygen. Sum it all up: when the adult is starting to dump off its oxygen, the fetus is still holding tighter to its oxygen, so it collects any oxygen that the woman's hemoglobin is releasing.
Here's the trick--fetal hemoglobin is just slightly different from adult hemoglobin. At birth, the baby stops producing its fetal hemoglobin, and starts producing adult hemoglobin, since it's ready to start breathing on its own.
I'm afraid I'll be exhausting this theme a little early, (seeing as though I haven't even started school yet) but I seriously can't get through five pages of biochemistry without being sucked down the Tunnel of Wonder&trademark;. If you've never experienced said Tunnel, it's kind of hard to describe. It's something like the Malkovich portal in that, once you open the door, it sucks your mind in, and you're immediately off daydreaming about your body.
In some cases, it leads me to this chicken-and-egg, Mobius-strip confusion and complexity. Just a couple days ago I was reading about glucose, the basic sugar molecule that, for the most part, powers us all day long. Your brain requires glucose--it can't get its energy from fatty acids (fats and oils), like the other tissues of your body can--so your liver, which helps regulate your blood's glucose concentration, samples your blood to make sure that, at the very least, your brain's got food. After reading all of that, I dove headfirst into WonderWorld. I began thinking, "Okay, so my liver's always making sure my brain has energy, and now I'm (my brain is) learning that my liver's doing this. So now, my brain has stored this information in its memory, so it's aware of how it feeds itself. But then, is it my brain that's aware, or is it me? Am I my brain?" Repeat ad nauseum, or until I get a phone call or something.
"I take it all back! I didn't mean it! What was I thinking?" were my initial panicky reactions to the re-start of school in little more than a month. We have an online biochemistry course that we have to complete during the summer and fall quarters, and luckily I just found out that I passed out of it from my undergraduate course work, but still, reading the professor's notes gave me quite a flashback. Her warning that we "should submit quizzes only once," and that we have TA's for the class shook me up enough to realize that I'm actually starting school again, not just entering happy-fun-exciting world out West.
I was kind of excited at first, seeing all the classes online, as well as an online greeting from the professor (even more reason to feel like I picked the right school). And although I'm dorkily excited to review cell membranes, protein folding, hemoglobin structure, and the glycolysis cycle, my romanticized version of med school as just some fun thing I do, where I just passive absorb (download) information easily without recall failure or any ounce of effort or hair-pulling, is quickly fading from view. I once rationalized my, erm, cushy, low-stress non-profit job this year as a nice break for my brain, but what if it's been sitting idle for too long, and now I can't get it to start again?
I know deep down that most of these fears are completely unfounded, but I think I do it merely for the psychological edge. If I'm not sure I can succeed, and I do, then I've proven myself to be able to accomplish another feat. Let's just hope I don't fail. If that happens, then I'm totally screwed.
And now, the more I think about this, I'm wondering, "Should I be telling people about my doubts publicly?" I'm supposed to be people's doctor in a couple years. I'm not sure if I'd want to know that my internist was worried about memorizing, before she even started school. Yikes.
I chose this medical path. I may have not been fully aware of the life or the culture or the system in which I'll be working, but it's my doing. The $120,000+ debt, the long hours, the physical and emotional exhaustion, the paperwork, the monotony, the stress; the excitement, the joy, the career, the opportunity, the adrenaline rush, the wonder, the science, the body, the people. The bad and the good, the yang and the yin; I want to embrace it fully.
One of my medical heroes, Dr. Quentin Young, has told me that "medical school is the best behavior modification system the world has ever seen." He warned me that through all the on-call nights, the pager (cellphone now?) beeps, and stress, doctors begin to think they deserve a better or higher-class life. Or even that I'm above some of my patients. But after all the sleepless nights, the stomach ulcers, and baggy eyes, there's no doubt in my mind that I'll still be better off than most of the world, and still probably most of the United States. It's not just me that deserves a better life; it's everyone. And I don't want to lose sight of that fact.
I finally got in touch with my med school cohort and good friend, Edna (she's at UT-San Antonio) and she's already started school. They have a month-long "orientation," to kind of acclimatize people to the med school environment, meet their classmates, and take a low-intensity class. Edna and I went through all the pre-med hell together--late nights studying Organic Chemistry (Orgo), Biology (Bio), Physics (Physics), Physical Chemistry (Gen Chem), the MCATs, the application process--everything. And now, she's there! She's starting med school!
It's hard to think of the long process ahead of us--and that she's already begun. It's a feeling that's hard to describe, somewhere between a dream and a goal, like this major life step that I've been envisioning since I was little. It's exciting for me, no doubt, but it feels like I've come to this cliff in my life, where things aren't so definite or planned for me anymore. My goal has, more or less, always been "go to med school," but the future plans always kind of just stop there. Now that I've almost passed this hurdle, I don't know what I'm going to strive for next. It's exciting, but still a little scary, even if it's subconscious.
I'm putting this weblog together, as an attempt to give others an insight into what medical school is like, how your doctors are trained, and hopefully, give readers a little insight into why anyone would be masochistic enough to want to do something like this. For me, it's the human interactions and the science. If you don't know much about the human body, I'll try to teach you some of the more interesting snippets. It's the most humbling and appreciative feeling in the world to learn how absolutely delicate and complex our physical bodies are--and how amazing that for most of us, it works right, 99% of the time.