A busy beginning

Fourth year has suddenly begun in a pace faster than what neither I, nor my colleagues, could ever anticipate. The first four courses, ranging from a week each, included Clinical Anatomy, Bioethics, Psychotherapy and Immunology - the latter still ongoing.

Additionally, Pharmacology just won't cut us some slack that easy and hang over our shoulders as a grim shadow and reminder of the final exam to come, with both practicals and lectures running simultaneously.

So, from "early" morning to late evening we've running between the weekly yawn-generating morning subject and the busy Clinical Anatomy dissections in the afternoon until about when both the hour and minute hand of the wrist watch point to six.

I think we all knew that the exams will be plentiful this year so mentally we settled with the idea of taking exams more or less every week. However, time is a precious resource and one have to spend it wisely in order to manage the exams in such short notice, especially when being used to have weeks for preparation as was the case in the second and third year. Using the time in between lectures is a good idea, and pushing oneself to go on reading after school and at weekends is paramount.

Fortunately for me anatomy comes easy, as I've repeated it during second year. This gave me some time to focus on the other topics, i.e. biomedical ethics and psychotherapy.

Unfortunately, to my big disappointment, these topics seems to be of rather low priority and judging after the event I think I spent too much time in proportion to the actual gain. A real shame indeed, as I believe ethics will be an important part of the future praxis.

Back to exams. When to take exams and general planning of one's studies is alwas a topic of discussion among us students. I figured that booking them as early as possible would be the way to go and it proved to work out well so far. Postponing only makes a student's life difficult, even thou doing so is tempting.

Semper Paratus, Scientia ac Labore, no procrastination

Why the "DIET" in Diet Coke is a hoax

I think it's great that someone actually explained this properly.
Not only will it give you the answer of the stated premise but also a great insight in the metabolic activity in the body in relation to pH

The Final Battle

The day before my exam I was still in the roller coaster clinging tight to the seat waiting for the ride to culminate. Kristýna had come return home to Prague a couple of days earlier (oh, how I was happy about that) and we spent the night having a picnic by the river, going over some last topography and finished it off by watching the amazing film Perfume - The story of a Murderer. If you haven't seen it I recommend you to do so.
 I woke up earlier than I had to and got ready to eat and suit up. Eating is the worst thing before exams and even thou Kristýna made me an amazing sandwich with everything you'd ever wish for I was not able to eat even half of it. I turned to my backup plan: smoothie. You can put almost anything in there and it's easy to take in, even when nervousness inhibits your appetite.
 The walk to anatomy department was very hot, it was indeed a god day, so I had to take my jacket off. The atmosphere in the building was really at unease. Most of the students from both the national and international parallel were already there - and I thought I was early with 15 minutes on the safe side. I found three friendly faces outside and we immediately started to share our thoughts about what was about to follow. I honestly cannot recall the great many things we discussed; "what-if"'s, "I-think"'s and "I've-heard"'s. I am, as you might have understood from earlier posts, not a man that speculates - however, even I had a difficult to brace myself.

The announcement finally arrived and we were summoned in the small lecture hall. A division was made and we international students ended up together with what I guess were 1/3 of the national students. We placed ourselves accordingly to the organization made by the exam assistants and after a quick introduction the slides began. I will not give details about the test itself, since a summary can be written in an earlier post.
 It was much more difficult than I anticipated. The slides were often of unknown origin, i.e. they are from an atlas or painter I, and I believe many other international students, did not recognize. With this said, the ability to be able to apply your specific knowledge from one atlas to schemes from another is very much valued. After all, the anatomy, in theory, is almost all the same - with variation of depth of details of course.
After handing in our tests we were sent off to the lobby with time to kill - and anxiety to suppress. We gathered again and started to deal with reason and non-reason. With no certainty of one’s grade, and I should here mention the 21/30 to pass limit, we all compared answers and possible mistakes.

I scored 22 and a sigh of relief, yet slight disappointment, left my lungs. I was through to the next round. Students who did not pass the introduction test had to leave and those left among me, a good 60%, left off into different directions depending on what examiner they got. Of us international student I believe no one got the same examiner. There were two of the examiners I really dreaded; Prof. Elizka and Prof. Druga. They are both amazing anatomists, the former in lymphatics and the later in central nervous system, which is a good reason why one should be humble once facing them.

I was led to the practical part of the exam first and to my surprise the professors were not examining here. It was both organized and held by docents and their assistants which, was sort of a relief at the moment. This part did not present much fear nor problem to pass for me. The knowledge from the studies during the summer dissection course, not too long ago, was still rather fresh and well embedded in my spine. Since I had to wait a good hour to get into the practical I understood that I would be one of the last to go to the oral part – a prediction that later proved to be correct.

Inside Prof. Elizka’s office posters of lymphatic systems were hanging from the walls both high and low and boxes with unidentifiable items were placed into towers in every corner. It was a very comic scene that hit me as a nice mind break in all the stress. Take notice, I would never call a Professor’s office messy so what I describe is a creative chaos much convenient to the person behind it, but certainly not for a confused and stressed out student.

Five national colleagues were already present preparing their presentations by scribbling down as much as their brainpower could afford in the pressing heat from outside streaming in through an open window in the corner. I looked around and nodded politely in a good luck meaning manner to those who met my gaze. The assistant that had showed me the way to the office showed me my seat and I was given a bunch of papers from a stock of what looked like a well written, formal document in Czech. “Not what one expect on an exam…” I thought and followed it up with “…but recycling papers are a great thing…!”.
I prepared my pencils and the assistant approached with a bucket. Inside were the questions and I randomly picked a number coding for this set of questions:
- Muscles and Fascias; of the back.
- Kidney; structure, syntopy and blood supply.
- The Eye; blood supply, ciliary and pupillary reflex.
- CNS; spinothalamic-, spinoreticular- and spinotectal tracts.
 I was at first puzzled by the set of questions and did not know where to start. I began by drawing as much as I could about the kidney since it was, in my opinion, the easier question. After that I sort of jumped from one drawing to another since I didn’t know how much time I had left. I understood from the order of students that I would be the last one which meant that I had four students ahead of me equal to about 20 minutes minimum each. After I had drawn for what felt like 3 hours I was finally done and couldn’t possibly get more out of my head. My six pages were filled with drawing from different angles showing different structures and I began to plan in which order to present them. Since I didn’t write more than one sentence I also had to come up with what to actually say.

This is the actual schemes I drew, however one page is missing:




 All of a sudden my time was up and the last student before me unfortunately for him did not pass but fortunately for me I now thought that this opens up a chance for me to perform better an impress. Because that is what it is about – to impress the examiner with your knowledge and ability to present it.

In a regular fashion Prof. Elizka wanted me to begin with the CNS question about the spinothalamic tract. I presented my scheme, which he was very pleased with, and I just brainstormed as much as I could. He then did an unexpected move and asked me about the reticular formation, a complete different structure within the brain but with connections to the spinoreticular tract. I was at first caught off guard but came back in the game and could move on to the second question. With the nice backup of my schemes (I once again argue in favour of schemes) could rely on always having the knowledge approved in illustration. I have really no idea how long my exam lasted, time is not of the essence as you are getting hit by question after question but I remember that it ended in a neat discussion about Sweden since Prof. Elizka recently visited a congress there.

In risk of being too self confident I can end by saying that I was very satisfied with my performance and I am glad that the grade reflects my ambition. After the even I can say that it is a very good experience to be put in the hot seat in front of someone of great importance and with a level of studies that exceeds your own by a thousandfold.
Gratitude is also to be able to have such an examiner that allows discussion about the subject and lets you correct yourself if proven wrong. Being well prepared is the key retrieved by repetition and practice in presentation of the subjects.

Next challenge is Histology which I fear will be far much worse. For now, good night and may reason strengthen your mind...

Preparation Propaganda

I’ve already implied many times that my main way of studying anatomy is through drawing. For anatomy all you really need is a good atlas, a source for regional dissection topography and a source for PNS and CNS pathways. I can write a whole chapter on which literature to prefer and for the beginning of next semester I hope I can share my thoughts to the first year students.

The first thing I should have done differently in anatomy was to print the exam questions in the beginning of the course, not in the end. It is true that you answer a lot of the questions during the year but it is one thing to know the fact and to be able to present it. I started with the first questions and it took me a great deal of time to write it all down. I understood that this was not the way to go so I started to build simple skeletons of the questions with criteria I had to cover.

By putting up a simple model of each question and by repeating the anatomy in the atlas I was able to recall the knowledge – it is true that once you’ve touch a subject, even just briefly, the knowledge comes back to you. There are some questions that require more theory than others, for example the general structure of bones and muscle, so those you must read up on a lot. More straight forward anatomy questions I found being up to date in my head and I spent little or no time on those.

I was told that being able to draw something about everything was a good way to go and I spent a lot of time repeating my schemes and drawings just to get the details right. My girlfriend Kristyna, who’s in fifth year of her studies and an anatomy assistant, helped me out by listening to me – mostly via Skype since she were by this time about to end her vascular surgery Erasmus exchange in Helsinki, Finland. Reading up on the questions and presenting them for someone is a great, and perhaps the very best, way to practice for the oral part of the exam.

I also found out that having a drawing to relay on during the presentation is, at least for me, essential. If I forget something I can go back to the drawing, re-present the statement and even expand it by adding things as I go.
Some of my preparations were drawings only, and I just kept the written things in my head, some examples below:

The Structure of the Final Anatomy Exam

I will write as if anatomy is a subject of the past without revealing too much - thus keeping the final battle review unwritten for yet some time.
There's a lot to cover leading up to the exam and one part is the preparation work and the anxiety that comes with it.

The system of the University is built up so that you need one ore more credit(s) from each subject in order to advance to the next semester. Credits are obtained in the end of each course, or earlier if one manage to pass a special test. They are earned by staying within the limited amount of absences, usually four, and by passing all the checkpoint tests during the course.
Of course all the tests tended to accumulate during the end and one have to plan it correctly. As the analogue signatures of credits are getting signed in the index book, or "the golden book of God" as one of my friends once put it, one can seriously starting prepare for what really matters: the final exams.

The Anatomy exam can be broken down in three steps starting off with a straight forward slide test composed of 30 images, schemes or drawings with one unidentified label respectively. You need 21 correct answers to pass to the next round.
All indexes of the students that passed are then collected and randomly distributed to the professors, thus, you never know which examiner you will face until after the slide test (not that it would matter).
The students that failed are being called and sent home while the rest are placed with their examining professor. Two further tasks must be conquered; the practical dissection and the oral examination. Some students begin with the practical part and some directly to the oral.

The dissection is rather straight forward. You enter the dissection rooms to your examiner who starts of at one of six stations: bones, cadaver (muscles), thorax, abdomen, brain and CT/X-Ray. You answer the questions and are graded accordingly.

In the last part of the final exam, the part that you in my honest opinion ought to fear the most, you will be forced into a face off with one of the professors. The oral part is composed of no less than 191 questions, or rather, categories. Out of the 191 you pick a randomized number coding for a set of four question. Here are the division, total number of questions for each category (in brackets) and some examples:

Skeleton and its connections, muscles, fascias, osteofascial compartments (30)
-Bones and joints of foot including X-ray images, plantar arches and their support
-General features of striated muscle, its auxiliary structures, motor end plate, motor unit, muscle spindle, Golgi tendon organ, denervation atrophy
-Muscles and fascias of thigh, femoral triangle (draw transverse section and boundaries)
Gastrointestinal tract (17)
-Pharynx – description, syntopy, blood supply, innervation, swallowing reflex
-Liver - structure, nutritional and portal vascular bed, intrahepatic bile ducts
Respiratory system (8)
-Trachea and bronchi, bronchial tree - description (draw scheme), structure, syntopy, tracheotomy
-Pleura – visceral and parietal, borders of pleura, pleural dome and recesses, pneumothorax
Urinary and reproductive system (15)
-Urinary bladder – structure and position, fixation and syntopy in male and female (draw scheme)
-Prostate - structure, topographic relations, prostatic urethra, ejaculatory ducts
Heart (7)
-Heart - description, chambers, heart wall arrangement (draw section through ventricles)
-Coronary arteries, coronarogrpahy, veins and nerves, lymphatics
Arteries (9)
-Common carotid artery, internal carotid artery
-Abdominal aorta, unpaired visceral branches and their clinically important anastomoses
Veins (8)
-Cranial veins, sinus durae matris, intracranial tributaries of internal jugular vein
-Superficial and deep veins of lower and upper extremities, varicose veins
Lymphatic system (8)
Central nervous system – CNS (29)
-Cerebellum – structure, subdivision and functional organization
-Association and commissural fibers of hemisphere, internal capsule (draw scheme of tracts in internal capsule)
-Lemniscal system (dorsal column tract), proprioceptive and tactile sensation
Peripheral nervous system – PNS (20)
-General structure of the spinal nerve, perineurium, vertebromedullar topography, segmental innervation, radicular areas, dermatomes
-Radial and axillary nerve, paralysis
-Abdominal and pelvic sympathetic system, pre-vertebral plexuses and ganglia
Sensory organs, skin, endocrine glands (13)
-Eyeball (draw sagittal section), cornea, sclera and vitreous body
-Choroidea, iris, ciliary body, eyeball chambers, circulation of aqueous humor, glaucoma
Regional Anatomy (27)
-Topography of abdominal wall, blood supply, innervation and surface projections of abdominal organs
-Inguinal region, inguinal canal, hernias (draw schema of inguinal canal)
-Topography of supramesocolic part of peritoneal cavity (draw transverse section through lesser sac)

The complete list of questions is available here.
As you can see the categories are rather wide and wont cover all the possible questions the Professors can come up with - more or less anything they have touched (and to be honest also not touched) during the year.
I am amazed over the fact that all of us, who passed, have managed to learn such magnitude of information in 9 months of time. Combined with the knowledge of Histology we should be able to zoom in on any part of the human body and be able to explain the structures building up that part, both macro- and microscopically.
I hope the rest of my colleagues will fight for a good grade this week, the fourth round of examinations, and that their outcome will be satisfying.

Luck comes with the prepared...

Great Measures in Busy Times

As usual, I make a meme-spoof...

So here I am again, in a defensive stance against myself and the optimistic thought that keeping this journal alive would be a piece of cake. It most certainly is not.
You all most probably know why, especially if you've gone through the same thing and for those who yet have the experience ahead of them I will in the following posts tell you a bit of what to expect.

Since the previous time I posted here, about a sunny day filled with highlights if I recall it correctly, there have been both ups and downs.
March 22nd is the date stamp and, to be perfectly honest, all that follows is rather blurry.

I can happily say that I am alive and more than just alive. I lived through what might have been the most intense three months of my life "so far" - and with that said in quotation marks - I expect more of it.
If I look back the winter was just about to turn its back on us and spring came rushing in through the door. Anatomy and histology was just about to step up their games by introducing the head-on Anatomy Dissection course simultaneously with the Peripheral and Central Nervous System (henceforth PNS & CNS), all together stretching over one month.
I was prepared for a rough ride but when Histology finally swapped into developmental Embryology, a complete different subject, it just hit me in the face like a metal bucket filled with icy water - and by that I mean water first and bucket next.

As the finish line got closer for every day and with more and more material to conquer I entered a sort of pseudo-doubting roller coaster. The only way to cling on to sanity was to prioritize, hence, histology simple had to end up on the self for the time being.

With my mind freshly set on Anatomy there were days I felt I had it under control. I passed all my practical tests with good marks and was, with a good push in the back from Kristyna and my colleague Gal, almost ready to book a pre-term final exam.
CNS dragged me back into obscurity and that was the phases I gently swayed between; pre-term or not pre-term. Gal is amazing and I admire her for staying on track with her plan. Damn sure, she did it to the end - as one of the very first to fight and survive against the professors of Anatomy.
I failed in staying to the plan and scheduled my anatomy one week after the school ended, something that after the event seems to have been a good move anyway. Since I'm not much for "what-if's" I tend to save my energy not speculating whether it would have been better to do the pre-term.

The last day of school came to an end and the real preparation could begin.
My own final battle with Professor Elizka sure is a nice story, with an outcome that I am mightily proud of, and I am sure I will find the inspiration to give you the details in a separate post later on.

But for now I'm satisfied, and done, with wrapping up the prologue...

Holding a Heart

This week is all about the heart, a subject very close to my own heart. Even though today's lecture didn't give me much new knowledge I spent the time drawing, 1,5 hour result below.
I can happily say that I handed in my drawings to a Professor in the czech part of the anatomy department who obviously are interested. I hope he will like the originals and I'm curious to hear what he thinks and what he wants to do with them.

During Wednesday's anatomy practical we spent a lot of time in the dissection room studying the authentic heart. Holding it in your palm is a strange but exciting feeling.

As I said - it's all about the heart...

My new heart

It's so nice to be home, breath some west coast air and see all my folks.
Dad picked me up from the airport and we drove back home chatting about pretty much everything.
At first when I planned these two weeks of "vacation" I wasn't sure if going home was a good idea, but I'm not regretting taking the flight back home because when you see the family you understand how much you've missed them.
I won't forget to study, been going over the circulatory system once already, and my plan is to finish off the upcoming three systems.

I've had some time to relax and I've been continuing watching Gray's Anatomy where I left off and I've also been drawing - just finished the conducting system of the heart. I've spent almost 1½ hours and I must say I'm satisfied with the result, the shading was hard but I'm getting better. The base is from Netter's, conductive system of the heart:

the Heart

Scanning Printer Result

I finally boughtthe printer I've been looking for and four clicks on the website, four thousand CZK and four hours later it arrived.
I did the setup and eveything worked just fine. Finally I can scan my documents, print and copy.
I'll put up my sketches and and a neat test print. Some of them you've seen already so there will be a double post. Note that most of them are just quick drawings and I'm happy to reveal that I'm currently working on some drawings with a little more time invested in the drawing process.
Enjoy.

A breif history of butterflies and hurricanes

I was asked to publish more photos from my portfolio, this is a really old one from a series of photos shot in my parents garden - if there's someone out there good at species - then please let me know the name of this little guy.

I wanted to write a recap of New Year's Eve... not going to happen.
I wanted to write a recap of Christmas and the holiday... not going to happen.
I wanted to write a recap of my lecture for the students at my old High School... not even that, is going to happen.

All sadly due to the lack of time and energy.
You see, lately I've been occupied by winged creatures and hopefully, in a short matter of time, me myself will grow wings.
Now, unfortunately that's just wishful thinking and neither will I have more time on my hands nor will wings start to grow out of my back... It will, simply... just not happen.

This looks like a disturbingly depressing beginning and I can gladly tell you that's not the case - the other way around - actually a lot have happened, a lot of good things.
I can honestly reveal that a normal and sane person would probably be stressed over the situation regarding the studies; the pile is just growing but therefore not said the pace is decreasing, hence the reason to be stressed... and that's why it is great that I'm not sane at the moment.

While trying to stay insane, since that (briefly proved by my speculations above) obviously helps, I'm digging through that growing pile of work.
I just passed the final Czech test with a mark B which sort of boosted my insanity and what's left to conquer are the final anatomy and histology tests for this semester.
Anatomy is shouting "finale!" while throwing a slide test and a scheme drawing right in our faces - covering random parts of the Gastro-Intestinal System which some students rate as the toughest part so far in the anatomy studies.
Basically it consists of muscles, gross- and micro anatomy of the internal organs such as; the liver, gall bladder, pancreas, intestines (large/small) and other specific compartments not worth mentioning since my eyes and brain are starting to shut down this very second.
My plan is to go through the whole system, organ by organ and put it all together in the end applying that knowledge to as many different atlases as possible in one week.

Simultaneously histology did the feared jumped from level 1 to level 4, or rather; like playing Pac-Man with 4 times the normal amount of monsters.
Next test is the first real slide test on the samples of all the tissues we've been through so far, approximately 25 samples.
It's going to be the biggest challenge next week and preparing for it is going to result in a lot of coffee, and less time for very inspirational things such as hitting the Facebook update button 6 times per minute.
By now I can feel my own sarcasm slapping my tired face like bricks of concrete to a Shaolin Munk's head , and I apologize for that - I'm writing on pure will power now - but I guess no one dares to blame me since I've been studying since 17:oo straight.

In two weeks the last checkpoint will be reached; the final Latin test. I have high hopes for that test since Latin, or more correctly Medical Terminology, is very interesting and I'm very much admiring our great teacher.

I would like to write a novel right now but I think this will do for tonight. Now I'll enjoy the butterflies and hurricanes and with that said I'll close my eyes... take a deep breath... and... slowly... fall... asleep... dreaming about... butterfl...z..z...Z