Day 7: Hello Neuropathy and End of the Semester reflections

Be warned, the following is a long post. I suggest coffee or some hot tea to keep you awake.

Last Friday I was once again unable to do medical related volunteering at San Jose. Instead, I helped organizing medical records for the second time. Certainly, nothing to be really reflective about, so instead I will focus on some of the medical cases I saw this week at the Nerve and Muscle Center, ending with some reflections on how I did this semester. 

A little background first: I have been shadowing Dr. Aziz Shaibani, director of the Nerve and Muscle Center at the O'Quinn Medical tower, every Thursday morning from 8.00AM to 10.30AM since January. From peripheral neuropathy to myasthenia gravis, Dr. Shaibani focuses on a specific branch of neurology, dealing mainly with peripheral nerve damage. I really enjoy seeing the variety of cases he works with, mainly because he will take the time to explain some of the cell biology/immunology/biochemistry component of each disease to both myself and the patient. For example, myasthenia gravis is an autoimmune disease in which memory B cells block the acetylcholine receptors, resulting in severe weakening of skeletal muscles. As he explained this, I remembered from my fast-paced, super informative Cell Bio class that some acetylcholine receptors belong to the super-family of G-coupled protein receptors (GPCRs); from my immunology class, I know that polio-virus has a polypeptide sequence very similar to a polypeptide segment  in acetylcholine receptors, perhaps explaining non hereditary myasthenia gravis. It's great to be able to relate what I learn in the classroom to what I want to do in the near future, but a lesson in humanity was the most enriching experience I had today during shadowing.

Today at the clinic, Dr. Shaibani saw an elderly hispanic lady with a severe degenerative disorder. Currently, sensory nerves on her extremities are weakly responsive, she is unable to extend her arm more than 6-10 inches horizontally, and cannot keep her balance while walking. Dr. Shaibani informed the patient's relatives that she had a rare syndrome that, in less than three years, will lead to complete loss of control over her arms and jaw muscles, due mainly to demyelination of certain motor neurons; dementia is also likely. I guess what drove to write about this was how Dr. Shaibani said all of this, but the patient had no clue of what the diagnosis was due to language barriers. So when her relatives began sharing with her the details of her diagnosis in Spanish, I "saw" for the first time what it is to deliver bad news to a patient. When I woke up at 5:51AM this morning, the last thing I was expecting to happen was to be so emotionally moved by this one particular case out of the +30 I have seen since January. I imagine it was her attempt to speak english just to tell the doctor "pray for me" that left an impression on me. Previously, I had only focused on the scientific/medical aspect of each particular case I saw at the Nerve and Muscle Center, so to finally see the crucial, but sometimes neglected, compassion component to medicine has been one of the most valuable experiences I have had this semester.

Moving onto a different topic, this week I had the opportunity to gain some extra credit for Cell Biology by going to two very informative presentations. Rather than describing what I learned from the presentations, I rather share how my supervisor at my tutoring job was amused by the fact I was seeking to gain 6pts in a class with a +800pts scale. Sure, 6pts won't guarantee that I will get an A in Cell, nevertheless, I have few options in trying to improve my grade at this point. And this is what triggered a reflection on how poorly I felt I have done in Cell. From shadowing to working part-time, and leading/participating in four research projects to preparing for the MCAT, I truly failed this semester at finding a balance between class, extracurricular activities, and personal life. A 71 score on my second Cell exam is so unlike me that I don't feel Dr. Rosell got to see the academically smart and competitive part of me. If one could buy time, I would have purchased a few extra hours earlier this semester to improve my understanding of the principles and facts tested in Cell. I look at my answers from my first and second exam and become uneasy  by how unintelligible I sound, truly not the type of answers you would expect from someone looking into BCM's MD/Ph.D. program as his next goal.

I haven't lost all hope in scoring an A, though. I consider my teaching presentation to have gone well and feel confident about most of my answers in the take home exam. Let's see if the intense reviewing I have planned for this and next week help me in doing great on the Cell final. Then I can perhaps get excited about graduation, which I haven't done at all.

- yamal