Yes, I am still here. And I am not buried in a landslide (I appreciate the concern of those of you that asked if I was affected by that tragedy).

Though I haven't written in a long time, it is not exactly revolutionary that I would write you an email. However, it literally took a revolution in order for me to get the time to to write to you. In case you haven't heard, there was a coup attempt here, this Friday morning, that was squashed. It started innocently enough, with mass rallies being held commemorating the 20th anniversary of "People Power's" peaceful overthrow of dictator, Ferdinand Marcos. The economic stagnation over the past 20 years had people questioning whether prosperity is the handmaiden of democracy. Furthermore, alleged voting fraud in the recent presidential election exacerbated the malcontent. When you have several hundred thousand people in the streets demonstrating, some thought the time was ripe for, what a capitalist would call, a hostile take over. Although very few injuries were reported, what resulted was the military shutting down major arteries, and, ultimately, regarding me and this email, all classes being cancelled.

The funniest part was that the locals were far more concerned about traffic obstructions than they were about any potential political changes. My class president feels that this may continue, suspending classes for a week or more.

Remember back to my last email, when I said I was getting excited and ready to study again. Well, I did. I got off the plane and hit the ground running.

Right into a wall.

Metaphorically speaking, I groggily got up, and then the wall fell on me.

Incredibly enough, it is not biochemistry which is causing me my greatest consternation. It is a new subject called Neuroanatomy, which replaced the time slot for microanatomy. Permit me to explain:`with biochemistry, if you do poorly in that class, it remains relatively isolated. Don't get me wrong, there is biochemistry in other classes I am taking, particularly physiology, but those classes generally limit the minutiae of the biochemistry they throw at you. In other words, the other classes tell you the biochemistry that you need to know pertaining to that particular subject. That is exactly what does not happen in Neuroanatomy. If you don't understand/memorize EVERYTHING in the book, the spill-over effect into other classes can be disastrous. So, not only are you floundering in Neuroanatomy, but Gross Anatomy and Physiology as well. Fortunately, most people feel this way. The only exception are the Physical Therapy students. They took 2 years of this, 1 of those years under the same teachers (if they went to FEU). We are packing even more information into less than a semester. For the moment, I am able to barely keep my head above water in gross and physio, but the neuroanatomy questions in both classes are really pulling me down. And, naturally, biochem hasn't gotten any easier.

What makes neuroanatomy so difficult? I mean, it's just the brain and the spinal cord, right? Yeah, that's all. But every lump (aka gyrus) and dip (aka sulcus) is important. And that is just the part with which most people are familiar. Turn the thing upside down, and it gets even more complex with the brainstem and spinal cord. Next, you cut it in half and look for very subtle shades of gray and white. It goes on and on. Beyond that, there are pathways that you really can't see in the specimens (we actually sawed open the skull of our cadavers and pulled the brains out to study) that are critical in every other organ system in the body, from shivering to urinating. Sometimes these pathways can cross, but sometimes they stay on the same side. Then, the faculty plays these games, which I like to call "Where's Waldo -- the Friendly Neighborhood Lesion." Basically, if a patient presents with certain neurological symptoms, you should be able to describe where the problem is. Ahhh! I find it very confusing.

The one class in which I am truly excelling is Medical Ethics. Ironically, the students that are doing well in the sciences are struggling in this class. It just goes to show, you can't be an ethical physician while being technically competent.

What all this means for me is that I am sleeping even less than I was last semester, and stressing out even more. In the neuroanatomy class, I have yet to break over 60% on any of the tests, despite reading, rereading, and rereading the material. Now, there are those that are doing worse, far worse than I, but how can you compare yourself to other students? As the cases we review prove, this is a critical skill for a clinical physician to possess. Something that can't be glossed over, but must be mastered. Mastered? At this point, I am happy to just be able to spell all of the terms correctly.

I have taken to viewing sleep like a currency, and one that you are issued a credit card. You can "over-draw" the account, but, if you repay it right away, there is no penalty. If you don't, well watch the interest build. If, for some reason, you don't make a minimum payment, Guido comes calling. I find myself nodding off in everything from lectures to labs (something to see, when I do that in Gross Anatomy lab) and sometimes even exams. I catch myself when my head impacts with the table.

It used to be, I could get a full 6-8 hours on Friday, and sometimes Saturday nights. Terror of tests (we have at least two every week, sometimes up to 4) keeps me up on Fridays, and wakes me up with the sun Saturday and Sunday mornings. With final exams only 3 weeks away, I am praying to just be eligible for the Neuroanatomy removal exam (if you don't know what a "removal" is, I mentioned it on a previous email that you can access here: http://www.caangay.com/ephraim-medschool/mentalmeanderings_copy(11).htm). I will most likely have to take the biochem removal, and I may be required to take either Physio or Gross or both.

And don't think that exams are the only things we have to do. We still have papers that need to be completed and turned in (the English major in me cringes at the cut-and-paste plagiary that is rampant here), presentations to prepare, and projects to research, with everything coming to a head at the end of the semester. As usual.

Anyways, I look forward to hearing from you.

Ephraim

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