Alcoholics Anonymous, Part 2

The Alcoholics Anonymous meeting I went to this afternoon was pretty much what I expected it would be: a bunch of people sharing the ways in which alcohol has destroyed their lives and seeking strength in others in the group to remain sober. The setting: a community center basement that looked like an Elk's lodge from the 1970's with fake wood panel walls covered by yellowed posters of motivational phrases like "Live and let live." Everyone in the group was in their 50's or 60's and looked like they had lived hard lives.

The group was led by a sweet lady, a Betty White look-alike. I never would have guessed that she's a recovered alcoholic. She started the meeting by asking if anyone wanted to share anything with the group. When no one said anything, she shared her own thoughts: basically that she is grateful that God brought her to Alcoholics Anonymous, grateful for the people who she has met through AA, because otherwise she is sure she would be dead.

Then other people shared. Each person opened by saying "My name is John Doe, and I'm an alcoholic." Or a recovering alcoholic, or a recovered alcoholic. Everyone then said "Hi, John Doe!" And when that person was done sharing, everyone said "Thank you, John Doe!" Just like in the movies.

Most everyone had similar I-would-be-dead-now-if-not-for-AA stories except one woman who must be in her 40's but looked at least a couple decades older. She told us how she's stuck on Step 4, how she just can't seem to get the pen on the paper. She had been in and out of AA over the years but is determined to make it through all 12 steps this time. I watched her as she spoke. I could see the desperation in her eyes; I could feel her sincere and desperate desire to quit drinking in the way she spoke and held herself. But I also saw fear and hopelessness that can easily lead her back to drink.

I don't know how her story will play out, but I did recognize how valuable Alcoholics Anonymous is to her efforts to stay sober. She has a clearly defined goal right now: to make a searching and fearless moral inventory of herself. Beyond that, she has a pathway to recovery laid out before her, providing her with goals to work toward. But I don't know whether she has a good sponsor. It's my impression that a good sponsor is key to a lasting recovery.

Eventually, the group leader asked if I wanted to introduce myself and share anything. I told the group that this was my first AA meeting; before I could finish my sentence, everyone was clapping! I went on to say that I was there not as an alcoholic but as a medical student with the purpose of learning more about Alcoholics Anonymous. Everyone was very welcoming.

The meeting wrapped up with everyone in the group holding hands in a circle and saying a prayer. It's a good thing that I was prepared for the spiritual aspect of AA because it would have caught me off guard otherwise. Multiple people in the group said that the two most important things in their life are God and sobriety and that they wouldn't have sobriety if it weren't for God. Interestingly, these same people also commented on how they were initially uncomfortable with the spirituality that is so integral to Alcoholics Anonymous. I can see how spirituality is a double-edged sword: while a person's relationship with God can be a powerful modifier of behavior, the idea of God can be off-putting to many people for a variety of reasons.

Overall, I think it was valuable to actually experience an AA meeting. I now have a better appreciation of both the strengths and limitations of Alcoholics Anonymous.

Alcoholics Anonymous, Part 1

Alcoholics Anonymous partnered with our psychiatry and ethics programs last month to educate our class about the organization: what it is and is not, its history, and its mission. I knew very little about AA except from what I've seen in movies and TV shows (admittedly not the best sources). For example, I was surprised that AA is entirely apolitical, making no contributions to candidates and taking no stances on propositions or legislation. I was also surprised by the spiritual (not religious) character of AA, as is apparent in their iconic Twelve Steps:

1. We admitted we were powerless over alcohol — that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

In addition to this informational lecture, we were also given an assignment to attend an AA meeting. The idea is that we should have a good understanding of what AA is all about if we will be referring our patients to AA. For example, AA may not be so great for a staunch atheist.

I will be attending my first AA meeting this afternoon. It was surprisingly very easy to find a meeting. I found the Denver Area Central Committee of Alcoholics Anonymous website simply by googling "Denver alcoholics anonymous," then I clicked on the "meetings" tab. There are dozens of meetings every day around the Denver metro area, each one with its own flavor.

I have mixed feelings about attending an AA meeting. On the one hand, I'm very curious about what it will be like and the kinds of people I will meet. On the other hand, I wonder whether my presence will make some people there feel uncomfortable. Apparently it's common for health care professionals to sit in on open meetings to learn more about AA. Listening to some of my classmates talk about their experiences at AA meetings, I realize that it's a crapshoot as to what my meeting will be like. In fact, we were taught that we should instruct our patients to attend multiple meetings until they find the one that's right for them. So, I basically have no idea what to expect from my AA meeting this afternoon, and I'm going into it with an open mind.

Neurology block: A+

The neurology block has long since passed, but I feel the need to comment on how great it was. I really enjoyed this block, and not just because I had already studied much of the material and am interested in the brain intellectually.

First and foremost, the block's co-directors Dr. Ojemann and Dr. French brought a combination of sincere interest in our educational experience, passion for their respective subjects, and don't-take-myself-too-seriously humor that made going to class that much more enjoyable.

For instance, the famed neurosurgeon Dr. Ojemann was not above wearing a helmet outfitted with rams horns to demonstrate the C-shaped organization of the brain. He also made use of balloons and finger puppets to teach other neuroanatomical arrangements. Then there's the renowned pharmacologist Dr. French who raffles off tickets to Rockies games or Avalanche games during his lectures. It's obvious how much they both enjoy teaching, and they put together a course reflecting that.

Also, the course itself was refreshingly organized. Top on my list was having lecture notes printed out well ahead of time. This may seem like a trivial point, but it's surprising how previous blocks were not able to make that happen. I gain so much more out of lectures when I'm able to read the notes ahead of time and when I don't have to start out a new unit four lectures behind in reading.

I'm sad that the neurology block is over, but medical school is rapid-fire, and there's no time for looking backward. We're already knee deep in the next block: Gastrointestinal, Endocrine, and Metabolism (DEMS for short). We may have had to give up Dr. Ojemann and Dr. French, but we got Dr. Michaels in return - a fair trade.

Psychiatry thread

“Psychiatry and neurology are inextricably linked. Psychiatry is neurology that we just don’t know yet.” -- Dr. Filley

The psychiatry thread started last semester during the CVPR block (cardiovascular, pulmonary, renal) and consisted of three brief lectures spaced throughout the block. Each lecture was then followed by an interview with a psychiatric patient. We split up into groups of eight students, each group led by a couple psychiatrists and/or psychologists who facilitated the interview and learning experience. One of the eight students then conducted the patient interview in front of everyone else.

At our level of training and experience (i.e. none), interviewing a patient by itself is enough to get the adrenaline flowing. But being observed and evaluated by both professors and our fellow classmates makes the experience that much more anxiety-provoking. I conducted an interview last semester with a patient who suffered from anxiety and depression related to a serious cardiovascular illness.

The psychiatry thread has continued into the neuroscience block. Each week, we cover a different condition or disorder. So far, we have interviewed patients with PTSD, autism, Parkinson's disease, chronic pain, bipolar disorder, and schizophrenia. Next week we're interviewing someone who is dealing with a substance use disorder.


I'm having a lot of fun with psychiatry. I have always been interested in the brain - how it works, and also what exactly goes wrong when it's not working so well. Learning about neurologic and psychiatric disorders in the classroom is good and all, but I really value this more clinically-oriented exposure to psychiatry. First, application of knowledge is always rewarding. Second, this psychiatry thread has encouraged me to appreciate on a personal level the impact that these diseases or disorders have on the individual.

I may or may not become a psychiatrist, but I have heard several times that every physician - regardless of specialty - practices psychiatry on some level.

Second year so far: Neuroscience block

So far, the second year of medical school has turned out to be remarkably like the first year: lots of lectures and didactic teaching. That's no surprise and is in fact quite the norm in medical education. We're currently in our neuroscience block, which I'm particularly enjoying. Just like last year when we had laboratory sessions coupled with hematology and microbiology coursework, the neuroscience block has offered some reprieve from the lecture hall with hands-on laboratory sessions to better learn neuroanatomy and synaptic transmission.

The neuroanatomy lab consisted of examining a whole brain, a hemisected brain (cut down the midline), and a brainstem+cerebellum, in order to identify important neuroanatomical structures. I was somewhat taken aback that this 3 hour session was the extent of our wet lab neuroanatomy exposure. Incidentally, a classmate of mine sent out the link to a website that uses magnetic resonance imaging (MRI) to teach neuroanatomy. It's pretty fun to play around with, and you can find it at www.headneckbrainspine.com.

The synaptic transmission lab made use of frog leg muscle fibers (connected to their motor neurons) and different drugs (curare, neostigmine) to demonstrate manipulations of signal transduction at the neuromuscular junction. When the motor neuron is electrically stimulated, you can record electrical responses from the frog muscle fiber - and even make it twitch, if the electrical stimulation is strong enough. Application of curare blocks the neurotransmitter acetylcholine, which is the means of communication between the motor neuron and muscle fiber. Neostigmine has the opposite effect, stimulating synaptic transmission by making acetylcholine more available at the junction between the motor neuron and muscle fiber.

I learn well by doing and by putting information in context, so I found these laboratory sessions fun and particularly helpful.

First day of school

School starts tomorrow! I've bought my textbooks and school supplies, I've cleaned off my desk, and I'm ready for the new school year. In fact, I'm so excited that I can't go to sleep. I take comfort in knowing that I can look for solidarity to a fair number of my classmates who feel the same way.

Second year kicks off with neuroscience and an interwoven psychiatry class. Fun!

Orienting the class of 2014

Orientation Week for the first-year medical students happened this past week. I had so much fun during orientation week last year (particularly at the retreat) that I decided to volunteer the last week of my last free Summer to help out as an orientation leader. This consisted mostly of herding the first-years from one place to the next and making sure that no one got lost or swallowed by a whale or something else equally as frightening. I was also there to answer whatever questions they threw at me and to otherwise calm them that medical school really isn't all that bad. It was a completely different experience for me than last year, when I was the one awash in anxiety of the Unknown.

As with last year, the two-day orientation retreat in the mountains was a ton of fun. For me, the highlights of the retreat were the team-building games, hiking in the mountains with a group of first-years, and the party that the orientation leaders threw for the first-years. I don't know when else I would have had the opportunity to get to know the class below me so well. Especially because it's so easy to become myopic in my own medical education, I feel that it was very important to meet my future colleagues.

They're a great group. I'm every bit impressed by them as by my own class, which speaks to what a great job the Admissions committee has done.

Taking stock of year one: Advice for incoming first-years

With the second year of medical school fast approaching, I've found myself reflecting on year one. What worked well for me and what didn't work so well? Having gone through that experience, what would I do differently if I could do it over again? What advice might I offer incoming first-year medical students? The following are five suggestions that I wish someone had given me before starting medical school. Everyone is unique, and there are many different learning styles out there, so these suggestions should be taken with that in mind.

1. Preparation for medical school: learn what you're going to learn before you start learning. I wish that someone had told me to buy First Aid for the USMLE Step 1 and flip through it during the Summer before starting medical school. Don't go crazy - don't try to memorize anything - rather, pay attention to the topics and types of knowledge for which you will eventually be held accountable. This may seem like overkill to a lot of people, but I know that I learn best when I can put what I'm trying to learn in a larger context.

2. Hone in on what's important. Medical school throws so much information at you that trying to memorize it all might literally drive you crazy. Instead, learn everything conceptually then identify what must be memorized. When it comes right down to it, the first two years of medical school are about cramming as much medical information as possible into your brain and demonstrating mastery of that knowledge by performing well on the Step 1 exam. First Aid is basically a road map of what a medical student needs to know in order to do well on that exam.

Another student a few classes ahead of me, offering advice to those following him just as I'm doing now, suggested reading the relevant sections of First Aid before each block then taking important class notes in the book so information is centralized. I didn't get that advice until after I finished my first year, but I plan on doing that during this coming year.

3. Anatomy: spend as much time in the cadaver lab as possible. I didn't do this at first, partly because it took me some time to adjust to the reality of dissecting a human cadaver. I noticed a substantial improvement of my understanding of the material when I prepared well prior to each dissection lab and when I spent time outside of dissection studying the anatomical structures. Study in a group and quiz each other.

4. Anatomy: Use multiple atlases. Everyone is infatuated with Netter's Atlas of Human Anatomy. The drawings are very well done, and they are helpful in showing anatomical relationships. So when I was shopping around for an atlas, I naturally bought Netter's. I found that it wasn't enough, though, and I ended up getting a second atlas: Grant's Atlas of Anatomy. It's drawings may not be nearly as pretty as Netter's, but Grant's includes a lot of additional information not found in Netter's. There are photographs, radiological images, and tables that organize complicated information like the fascial layers of the inguinal canal or the nerves and of the brachial plexus. My mind works well with tables.

I understand that not everyone is able to buy two atlases, but that shouldn't stop you from studying from more than one atlas. The library has many copies of both Netter's and Grant's. You can also borrow an atlas from a second-year, or study with a friend who has a different atlas than what you have. Bottom line: during anatomy, get your information from multiple sources.

5. Study the way you'll be tested. For the anatomy dissection lab, that means quizzing each other by tagging anatomical structures with pins. For everything beyond anatomy, that means answering USMLE-style questions. Subscribe to a question bank and use those questions to study during the last few days before an exam. It's most important that you do this during the CVPR block, since that block marks a significant shift toward more clinical material. However, I think doing this during the Molecules to Medicine, Blood and Lymph, and Disease and Defense blocks would have also proven helpful for me. I only started using a question bank to study during the renal section of CVPR and immediately wished that I had done so for the cardiovascular and pulmonary sections.

There are many question banks out there: USMLE World, Kaplan, USMLE Rx. Those are all subscription services. There is also a free question bank called Exam Master available through the Health Sciences library website, and also an up-and-coming free question bank called WikiTestPrep.

With so many question banks out there, what is the best approach? I am currently using USMLE World because many people I trust have told me that their questions are most comparable to those found on the real test. Also, for now, I only use this question bank in "tutor" mode, which means that my quizzes are not timed and that I get the benefit of reading explanations for each question. If you do start using a question bank to study during your first year, do yourself a favor and don't time yourself.

The long white coat

I was running around University Hospital today and bumped into a friend in the elevator. I knew him back when he was a lowly medical student with his short white coat, a fourth year. But today in the elevator, my friend who used to be a fourth year medical student was sporting a long white coat and looking very doctor-like. "I'm just an intern," he dodged. "It's a very steep learning curve."

It felt gratifying to see evidence of the progression: that medical students do actually graduate, get an M.D. after their name, and become an intern. That implies that interns do actually become residents and that residents in fact end their formal training to become full-fledged doctors (after a fellowship, maybe, but that's beside the point).

Such periodic reminders of progress is good for keeping up the morale.

Financial aid for the Summer

Here at the University of Colorado School of Medicine, financial aid for the first year only covers until classes end at the beginning of June. Students are not typically enrolled in course credits during the Summer between the first and second years of medical school. This gap of financial aid coverage is problematic for many medical students who otherwise would not be able to cover costs of living.

This year, though, a new mentored scholarly activity (MSA) Summer elective course has allowed the school to plug the gap of financial aid coverage. Everyone has to complete a MSA project as a graduation requirement, and some students choose to do the bulk of the work during this "last free Summer" between the first and second years. Such students now have the option of signing up for this MSA Summer elective. Since these credits count toward a graduation requirement, students enrolled in this course are eligible for financial aid.

This makes my life much easier.