Where the heart is exercised equally with the head

Jolly O, top of the evenin’ govna! I am back after a two-month hiatus — and what better topic to write on than my first few months in Medical school. It has truly been a jam-packed schedule the past couple of weeks, what with the influx of knowledge on anatomy, biochemistry, histology and physiology. Add on project meetings, research and dance sessions to round up my first few months of college — I’m merrily basking in the enjoyment of them all.

Here’s a light and feel-good indie piece to complement this article.

Curiosity is the Mother of Discovery

What is the anatomical significance of the lingula? How do you choose between a needle and tube thoracostomy? Which structures are involved in the Thoracic outlet syndrome?

When must we question our knowledge, our textbooks, our notes, and to what end?

“The important thing is to not stop questioning.”

– Albert Einstein

Curiosity, he said, has its own reason for existing.

I seldom hesitate whenever I have a burning question, a query — be it in online lectures, tutorials or anatomy hall sessions. The joy of learning for me, is as indispensable in studying as breathing is in running. Questioning and learning are but an illustrated excursion into the minds of the noble and the learned!

Scholars have researched the importance of curiosity in medicine and concluded that it is but a habit of the mind. One that for doctors, is actually fundamental to understanding every patient’s illness.

Curiosity, they maintain, is pivotal to the development of sound clinical reasoning, something quite necessary in the often ambiguous world of clinical medicine. It is key to avoiding the rush to premature decisions based on incomplete understanding. It is also integral to deepening one’s self-awareness, and to build respectful relationships with patients.

“Any fun facts for me Alex?” Ahh, love it when me mates play such music to my ears. The same friends who then proceed to call me a nerd after sharing whatever I’ve learnt…

Silent Mentors

We stepped into the hall with minds boggling with questions. The six of us approached the table, the place where we would go on to spend every fateful Tuesday. Thrilling Tuesdays. We braced our hearts, to meet Them — The Cadavers, Our Silent Mentors. I said a short prayer.

For most, even those who have lost their loved ones, it would be the closest we’ve ever come to seeing a corpse. Lo and behold, we find ourselves manoeuvring the bodies trying to find the transverse humeral ligament, picking away at the neurovasculature to identify the popliteal vein, lifting flap after flap of tissue to locate the pectineus muscle.

“Prof! Where can we find the bifurcation of the intercostal nerve?”

Soon enough, we’ll be holding Their hearts in our hands, and appreciating the intricacies of Their brains. Ever so often I compartmentalise, going through my notes to run down the list of arteries, muscles and structures to find. I get so engrossed in it until I catch a glimpse of Their faces…only to halt in my tracks. Then I remember the significance of what I’m doing and why I’m doing it, and suddenly everything becomes so much more important in that moment.

Be it admiring His beautiful rectus femoris or getting walloped on my latissimus dorsi by my clinical group mate because I didn’t process “the intercostal vein, nerve and artery lie on the same plane in the costal groove”, I must say anatomy is absolutely enthralling.

We then scrub out and disinfect before heading out of anatomy hall. The aftereffects of the formaldehyde begin to hit us so very gently. A wretched feeling curls up like a ball inside of us as we head for lunch. Blistering barnacles.

Yet as always, we step out of the hall armed with newfound knowledge.

Where Science meets Philosophy

The Best Doctor is also a Philosopher.

Despite having studied Medicine for just a brief period of time thus far, I’ve come to realise that it is the middle ground where Science meets Philosophy. It’s where the concepts and theories you read in books, from Galen to Aristotle, metamorphose from speculation to action.

For Galen, a medical expert cannot afford to be ignorant of ‘natural philosophy’.

“Just as bodily health consisted in a balance of humours, so virtue consisted in an appropriate balance between psychological forces: the illness of melancholy was caused by an excess of black bile, the psychic malady of greed by an excess of desire. Admittedly, Medicine was usually seen as a discipline allied to Philosophy, rather than as an actual part of Philosophy. Yet Galen’s heirs were prepared to believe, not only that the best doctor is also a philosopher, but also that the best philosopher is also a doctor.”

– Peter Adamson on Medicine in the ancient world

Pathology and illness make you understand that all the things you were worrying about till then, were essentially harmless.The very realisation that you might die kills off all baseless thoughts of guilt, jealousy and revenge in you because these feelings, aren’t worth the definite amount of time you have in your hand.

A breathtaking conversation in Richard Linklater’s ‘Before Midnight’ underscores my point.

Céline: There was this friend of mine that, when he found out he had leukaemia, and was probably going to die, he confessed to me that the first thing that came to his mind was relief.

Jesse: Relief? But why?

Céline: Well, before he found out he had nine months to live he was always so worried about money, and now his thought was, great! I have more than enough money to live for the next nine months, I’ve made it!

Jesse: [laughing] Oh, okay.

Céline: And then he was finally able to enjoy everything about life, even like being stuck in traffic. He would just enjoy looking at people… staring at their faces. Just the little things.

Chocolate Cake Complex

I mean I love chocolate cake to bits, but if I was forced to eat it all day everyday even when I’m not hungry, I imagine I’d begin to dislike it.

Physiology and pathophysiology are incredibly fascinating subjects. Humans have literally worked for millions of collective hours to discover these little puzzle pieces that we piece together to comprehend and explain observable clinical and lab findings.

Yet, being asked to swallow this ever increasing and non-exhaustive expansive body of knowledge, and then regurgitating them out under time pressure, whilst at the same time being judged, evaluated and compared to your peers…isn’t particularly enjoyable. We’ve recently embarked on our Cardiovascular, Respiratory and Blood system blocks, and my days, let’s just say I’ve yet to digest the abundance of information.

Set the Pace, Pace the Set

These are 6 words that I’ve held quite dearly to me heart ever since high school. The beauty of Medicine is that it isn’t quite a sprint but rather, a marathon. It’s not a 42KM marathon no. It’s more like a 42 year marathon. It’s lifelong really.

Pacing yourself makes the arduous process that teeny bit more pleasant.

In Ras signalling, the activated receptor recruits Grb2 which binds to a Ras-GTP exchange factor. Ras-GEF catalyses the exchange of Ras-GDP for RAS-GTP which then activates downstream signals. Activated Ras recruits Raf kinase. Activated Raf phosphorylates Mek. Activated Mek phosphorylates Erk…Ugh bollocks, give me a break. Blasphemous I know.

I can’t see myself studying physiology or biochemistry for hours on end. Yet when you look at the big picture, don’t they always say ‘Communication is key’? The signals that are sent and received by cells during their whole existence are essential for the harmonious development of tissues, organs and bodies. They also govern movement, thought and behaviour. Without prior knowledge on cell signalling, how would doctors know to prescribe medicine that target and alter the cell signalling pathways responsible for the patient’s disease?

To that end, I suppose one can study Medicine without being particularly fond of it, but it certainly makes learning much more rewarding and enjoyable. Studying Medicine at the end of the day, is a privilege — It provides an avenue where we can seek to empower lives, receive constant mental stimulation and enjoy a continuous and lifelong opportunity to learn and progress.

Perhaps it’s still early days, but I know that whatever hard work I put in now will certainly pay off when I figure out my first diagnoses as a physician. I sincerely hope and pray that this fire in me continues burning bright for the many years to come. Set the Pace, Pace the Set. For now, it’s back to the books for CA2……

Alexander SR Pang