Thursday, April 22, 2010

Career-Affirming Moments

On Tuesday, we had a lab about hematology. We made blood smears, did differential white cell counts, determined total protein, and generally had a good time pretending to be real doctors. (And by "real doctors" I mean people who have graduated from veterinary school.) 

There are five major classes of white blood cells that circulate in health individuals: neutrophils are the most numerous, followed by lymphocytes, monocytes, eosinophils, and basophils. Eosinophils are fairly rare, but you can usually find one if you're patient. Basophils, on the other hand, are much rarer, and the pathologist teaching our lab told us not to even bother looking for one because we probably won't find one. This line is not unfamiliar, and I have spent wasted enough time looking for basophils (by "enough time" I mean probably 10 minutes out of the entire 45 minutes of my life that I have probably spent looking at blood smears) that the thrill of the hunt is completely stale. Other people have seen them, I believe in their existence, and that's good enough for me. To thrive survive in the world of science takes a little faith, sometimes. 

And sometimes, science rewards that faith. Like on Tuesday, when I, Jane Herriot, was blessed with the presence, in high-power field number eleventy-something, of what was confirmed to be, really and truly, an equine basophil. I was driving the microscope and my friend C— was sitting across from me looking at the slide through the second set of eye pieces (double-headed scopes rock!) and tallying cells. We were about half way through the differential white cell count. We finished counting the field we were viewing and I moved methodically to the next one. My eyes were met with this: 


C— and I looked at each other, the look that says, Are you seeing what I'm seeing? We called the professor over, and she confirmed our find! It was a great day for science.

The real career-affirming moment came today, though. We were sitting in the computer lab working through guided coagulation case studies, when the person sitting across from me mentioned having seen a basophil in hematology lab. "I saw one, too," I said. Person-sitting-across-from-me's lab partner looked at me in awe and said, "Can I touch your hand?!?"

You know medicine is for you when your classmates think you're a hero for finding a basophil on a blood smear.

Thursday, April 15, 2010

I heart physiology

I'm going to specialize in internal medicine. The most amazing thing is that I never knew how amazing and interesting physiology was until this year. Surgery is easy. Surgeons open their patients up, see what needs fixing, and fix it with sewing kits and Erector sets. Alright, which is pretty cool. But, internists!

Internists are detectives, ferreting out clues to the inner workings of their patients. Their hands pick up subtle differences in the size of lymph nodes. Their ears pick up faint sounds in the lungs. Some of them can even smell metabolic imbalances! In the midst of all the interconnectivity that is homeostasis, they find the soft spot, the organ that's not pulling its weight, the organ that's trying to steal the show. Then, they carefully select a drug from the pharmacy that will set things in order. Willy Wonka would have been an internist.

I mentioned interconnectivity, but that was an understatement. No cell in the body does anything on the sly. Right now, I can consider approximately 2 organ systems simultaneously, and it feels a lot like trying to recall one song while the radio in the background plays a different one. To illustrate, the negative feedback pathway for osmoregulation, below, is about the maximum level of complexity that exists in my understanding today.

In contrast, the image below is a scientific attempt to characterize all biochemical pathways in one cell.  

Close up of N3, showing some steps in the metabolism of glucose.


It's no different from learning your way around a new city. At first, you might only know the way between school and home, and then, you might know how to get to the grocery store, but only from home. Eventually, not only can you get everywhere you need to get, but you also know the fastest way from school to the grocery store, whether or not you can stop at the bank or the gas station on your way there, and whether you should stop at the post office before school, on your way to the grocery store, or on your way home at the end of the day.

Eventually, I'm going to have that map in my head!

Physiology is an incredible symphony, isn't it? Our job is to learn to hear each individual instrument and to pick out the melody from the harmonies.