Clodagh O’Toole O’Shay O’Leary O’Mulligan

Yeah she’s Irish; deal with it! Her real name is Clodagh Mullen, pictured brilliantly to the left. In Part II of my series entitled “Wait, That Person Got into Medical School??” I am joined by a wonderful lass, who is most assuredly BFF caliber. Affectionately known as “Clo” or “the one who smiles a lot,” she hails from Cleveland, OH. Also on the eight-plus year plan at UNC-Chapel Hill like me, Clodagh is a Tar Heel born and bred, and thus represents everything that is good and right in this world. But don’t let her infectious smile and contagious laughter fool you; she’s as sharp as any knife in the drawer, and brighter than most cookies. As one of those elusive “out of staters,” she’s not just another pretty face. Clearly she’s got a wicked pair that got her past the admissions committee as a non-resident.

The details of the first time Clodagh and I truly bonded are a bit hazy (truly). It suffices to say that it was her birthday, I was throwing my credit cards on the beer pong table and ghost-riding the whip, and dog shit was involved. But just from those vague details, it can be inferred that we became fast friends. I have spent hours and hours pacing back and forth in her room, reciting the cranial nerves (“What nerve are we talking about, we’re talking about the facial nerve, that’s cranial nerve number VII, cranial nerve number VII is the facial nerve, the facial nerve has 5 divisions, 5 divisions, let’s start now with the branchiomotor, the branchiomotor…”). Since then we’ve been to Peru, Bolivia, and back, and I still have not annoyed her enough to defriend me on Facebook. She is the reason people call me “floppy,” and the inspiration behind my New Year’s Resolution to smile more.

After Clodagh graduated from UNC undergrad, receiving a Bachelor of Science in Psychology and minors in both Chemistry and Biology (and of course graduating with Highest Honors), she moved to Philadelphia to work for Teach for America. There she received a Masters in Teaching secondary education with a concentration in science from Chestnut Hill College, and also perfected her “teacher voice” (I have yet to see the wrath and her layeth the smackdown on anyone, but I hope it’s never direct towards me). She taught at Martin Luther King High School, and raised her students’ reading scores by 2.5 grade levels. Not only was she fantastic, but she now has unbelievable street cred.

So I asked Clodagh to send me her resume before writing this blog. Unfortunately, I don’t have the necessary musculature in my digits to type out all of Ms. Mullen’s accomplishments and service. I will list a few here, but know that there is much more to the story:

• English as a Second Language bilingual tutor for special needs students (fluent in Spanish).
• Health Teacher & Math and Science Teaching Assistant, Guatemala City (Clodagh returns every summer to a school in the Guatemala City garbage dump slums to assist the teachers with math and science instruction and teach reproductive health and nutrition classes to mothers and teens).
• Community Skills Instructor, Autism Society of North Carolina (works one on one with students with autism and coaches a soccer team for younger children with autism). Feel unaccomplished yet?
• Research Assistant, Biopsychology lab in Chapel Hill (researched the effects on brain functioning of alcohol exposed PKA knockout mice).
• Two time finalist at the World Championship of Irish Dancing (you know, no big deal – this also explains her penchant for a good dance party).

In fact, Clodagh has only one blemish on her immaculate record. Clodagh Mullen is absolutely obsessed with poop. That’s right, if you’re having gastrointestinal issues, she’s the one with whom you should speak. What color is it? Does it float? Yup, she asked me if it floated once. This obsession has allowed her to dominate small group discussions and anything mildly related to the colon. Frankly I’d be more concerned, but Clodagh does indeed want to be a GI doc.

In all seriousness though, I hope these vignettes offer a quick glimpse into the type of people who are the future of health care. I started with Alan Smeltz, and now with Clodagh, you can truly tell that the caliber of students accepted at UNC Med is phenomenal (minus the author of this blog, tee-hee). As the years go on, and I am able to profile more and more people in my class, your confidence in physicians should increase tremendously if you read between the lines. There are some pretty amazing people here.

Years later I hope to re-read these posts and smile. I have some remarkable friends and future colleagues.

Medicine in Society? Check.

As of Wednesday, April 21st, I have officially completed (and passed!) my first class in medical school. Next to the course Medicine in Society, on my transcript, there will be a fat ole "P" for passed. For some (cough, cough, Kelly), this is a cause for celebration, perhaps warranting an upcoming weekday excursion to Teavana, Inc. I, however, will miss a class that actually catered to my favorite learning style. When I look back at my most memorable classes in undergrad, Modern Democratic Theory, and Ethics, Morality, Liberty and the Law (both political science classes - hmmm, figures), they involved large amounts of group discussion and debate. They also questioned, and often changed, many of my views about different issues. Learning from people my own age, each with very different experiences and backgrounds, gives my own life perspective, and lends insight into the lives of others. Apparently not everyone went to The Georgetown Preparatory School for high school.

It would be unfair to say that every class had the same experience as ours. Many preceptors lectured to the class or made sure the discussion never deviated from the curriculum. I think we were lucky in that many of us got to hear background stories and other insights. Our class promoted political views from the hard right to the bleeding left (although it would also be unfair to omit the fact that the majority of the players sat contently in Obama's camp). Members of our section have worked in refugee camps, HIV/AIDS clinics, and have spent significant time abroad in third world countries. We represented different family identities and levels of socioeconomic status. There were at least two athletes that I know of, and two people who have obtained permits for concealed weapons. The age range was from 22 to about 30, and included a mixture of ethnicities. All these individuals questioned my beliefs concerning patient autonomy, the boundaries of a physician in her practice, medical ethics, and the legislation of morality.

If I were to take away one little golden nugget of insight, one gem, it would be this: the more I know, the more I know I don't know. Cliché as that statement might be, so many readings and statistics that we went over didn't really help to clarify the "right" or "wrong" way to look at things. And, the ensuing discussion seemed to only make the waters murkier. One discussion that stands out in my mind involved the ethical implications of students doing medical work abroad. I apologize; I won't be able to do the debate justice, but I will attempt to reiterate some of the key points. In my prior mind, this wasn't even an issue. Medical students often have an opportunity to go to third world countries, assist with many procedures, care for patients, and learn skills that they would not have yet learned here in the United States. For example, some students return in August with basic knowledge of how to sew and close incisions. They get real world knowledge years before it is legal to do in so the U.S. I had never thought twice about this practice. It seemed like a fantastic experience: helping others who desperately need medical attention, and who, perhaps, would never have received care.

Some members in our group, however, voiced their concern that this is much like the practice of medicine in this country years before many of the laws that now protect patients. The history of medicine is rife with examples of "using" the poor and disadvantaged for medical education and advancement. By leaving our borders to escape these laws that are meant for the patients' benefit, we educate ourselves on those who do not have those same rights and protections, performing procedures and learning technical skills that would not be allowed here in the U.S. There is a reason medical students don't spend significant time with patient care until their third year of school. But we, as barely educated first-years, can provide that care in the third world?

The conclusion that I came to was that any medical trip I might participate in deserves a high level of scrutiny. Who am I working with? Is this legal in the U.S.? What will be the consequences? What are my intentions? Is what I am doing the best for the people I am serving? I think (and hope) that for almost all the programs sponsored by UNC for medical students, the answer these questions would be, "Yes, I am doing good." But until now, I haven't even questioned the consequences of these opportunities.

And then we got into the ethical implications of medical mission trips. This blog isn't long enough for that debate.

We have one elective next year, so yesterday we listed our top eight choices (whether I get any of those preferred eight is to be seen; I am skeptical, to say the least). My top two were Health Policy with Dr. Jon Oberlander (of course), and The Medical Narrative (how to become a better medical writer). I would be extremely happy with either.

I am now nine lectures behind, and we have Exam #2 on Monday at 8 AM. Typical. Looks like it's time to get crackin'.

Alphabet Soup and Microscopic Bugs

Caught up in the hubbub of Peru, Vegas, and other extracurricular activities, I have yet to provide a mini introduction to Block IV: Immunology and Microbiology. I think this post is aptly appellated "Alphabet Soup and Microscopic Bugs," as Immunology is nothing short of memorizing tons of different complement factors (C1 thru C9), interleukins (IL-1 thru IL-12), receptors, chemokines, immunoglobulins (IgM, IgG, IgA, etc.), and a myriad of other biochemical molecules. And Microbiology is simply memorizing bug after bug after bug, from herpes to the HIV to the flu. Structure, classification, staining, life cycle, symptoms. However, this Block is incredibly important, as it is the only time in the first two years where we study these topics. Next year we will review anatomy and physiology as we study the pathophysiology of each organ system, but not the material covered in the next few weeks. This Block is also fairly comprehensive: these are most of the infectious organisms that we will have to know in and out as physicians. So a year from now, this will be a very important part of our first milestone, the STEP 1 exam. Plus, I find both fields fascinating and relevant (very exciting since I have struggled to find the relevance of some of the material covered so far).

To provide an example of the ridiculous amount of letters and numbers that require rout memorization, I have selected to detail the alternative complement pathway (courtesy of Wikipedia). "Complement" is a biochemical cascade that helps the antibodies in our body clear pathogens. It is part of the "innate" immune system, which means that it is one of body's first responders to infectious disease. Essentially, these molecules act as little markers on foreign cells, waiving the red flag saying, "Hey! This guy doesn't belong here! Kick him out!" They are, in more preferable vernacular, the tattle-tales of the immune system.

"The alternative pathway is triggered by spontaneous C3 hydrolysis directly due to the breakdown of the thioester bond via condensation reaction (C3 is mildly unstable in aqueous environment) to form C3a and C3b. C3b is then capable of covalently binding to a pathogenic membrane surface if it is near enough. If there is no pathogen in the blood, the C3a and C3b protein fragments will be deactivated by rejoining with each other. Upon binding with a cellular membrane C3b is bound by factor B to form C3bB. This complex in presence of factor D will be cleaved into Ba and Bb. Bb will remain covalently bonded to C3b to form C3bBb which is the alternative pathway C3-convertase. The C3bBb complex, which is "hooked" onto the surface of the pathogen, will then act like a "chain saw," catalyzing the hydrolysis of C3 in the blood into C3a and C3b, which positively affects the number of C3bBb hooked onto a pathogen. After hydrolysis of C3, C3b complexes to become C3bBbC3b, which cleaves C5 into C5a and C5b. C5b with C6, C7, C8, and C9 (C5b6789) complex to form the membrane attack complex, also known as MAC, which is inserted into the cell membrane, "punches a hole," and initiates cells lysis. C5a and C3a are known to trigger mast cell degranulation. IgA is associated with activating the alternative path."

That is one of the many pathways we had to learn for our first exam.

We started learning about microbes this past week (and my lack of an example shows you that I'm already a week behind). But we also have enjoyed a couple small group and laboratory sessions. I honestly wish I could detail what we are learning in lab (besides Gram staining), but I'm more of a "laboratory technician" than a true "scientist." After I proceeded to break half of the glassware in my drawer during Organic lab with Becky Smock, and then blew up my fair share of UNC MelTemps, I figure it's better to just do what I'm told. I'm tired of owing the Chemistry department money at the end of each semester. My partner, Austin Hester, tells me to swab the petri dish, and I swab the petri dish. If the table needs cleaning or 20 wells each need 14 drops of buffer, I do that as well. Yeah, I've never been much of a "lab" guy. I guess that's why my greatest accomplishment in my year of undergraduate research was "providing the lab with a more festive environment" - courtesy of my PI.

And so, I prefer working with macroscopic organisms instead of glassware and microbes.

Back to Reality

The past few weeks have been nothing short of memorable. I've been to Peru and Bolivia, co-authored a music video with almost 3,000 hits on YouTube, waged a truly epic war with bed bugs, and survived my first bachelor party in Las Vegas. And that is why this post comes so many days late. I had very limited access to internet in the Aria (pictured left), unless I wanted to pay a pretty penny to check my email. I had to send messages via Adam Schauer's BlackBerry, but that isn't very convenient for serious computing. Nevertheless, I am alive. I slept 14 hours last night, after the 4 day Vegas excursion and our first Immunology test early yesterday morning. Despite the debauchery that went down Thursday through Sunday, not only did I pass the preliminary exam of Block IV, but it was one of my better tests of the year.

I've learned a lot so far in my first year (more than just all that medical stuff). First off, I have discovered that I am totally unmotivated by the pass/fail system, although it has benefited me greatly, allowing me to succeed in many other extra curricular endeavors. Knowing that I only have to "pass" an exam has led me to make a music video, start up EMS again, host dinners and gathers, head to Vegas, and schedule everything and anything my little heart desires. But, I have learned how to learn the material. I purchased "First Aid's Guide to Step 1," and it has provided me with the most efficient studying I have ever done. Without going to or retrospective listening to lectures (the second-years told us that Block 4 classes were a wasted of time), I have thoroughly enjoyed scribbling notes and copying extra material into the outline of this book. (I'm going to do this for BioChem and some Physiology over the summer - shocking I know). And it has been the most efficient technique I have learned so far. This is even one of the study tips that experts give for acing the Step 1 Exam. Too bad it took me this long to get on the ball...

Now it is April, so almost one third of 2010 has already passed. Time flies too fast. But much has been accomplished, much of which is on my New Year's Resolutions list. Here's what I've done so far:

2. Actually diagnose somebody with something - I diagnosed a new Type I diabetic over Community Week. Thirsty all the time, polyuria, weight loss. All the symptoms fit. Tests were run and my preceptor agreed!

8. Make a YouTube video that gets over 1,000,000 hits - check this one off for sure. It'll never make a million but I'll take 3,000 in the first week.

11. Sit in the front row of the Carolina/Duke game - courtesy of Margaret Twomey, Clodagh and I were able to get tickets in section 127. Not the front row but damn close. And I thought I'd never go to another Duke game again... thanks Meg!

13. Get on track with some health policy research - looks like I'll be working at the Sheps Center here at UNC this summer. Topic unknown, but I will definitely be helping with many projects and networking. Finally some research I'm actually interested in.

15. Have "Med School Prom" be everything that real Prom should have been - it was unreal. Just read my blog entitled "Meg Twomey and the Pouch of Importance."

22. Change my bed sheets more often - I brought back some bed bugs from Peru. So instead of paying 600 dollars for a service, I decided to wage all out war on my room. Triple the insecticide doses, allergenic covers for my box spring and bed, room sprays, vacuuming, and hot water/dryer treatments to all comforters and sheets. So yes, I change my bed sheets more often.

That's 6 down and 20 to go! Right on track to passing :)

The Premiere

In its epic premiere, the highly anticipated debut of the music video for 5 Star Nerve (The Brachial Plexus Song) helped push the MS1s to victory at Skit Night. It has spread across YouTube and Facebook like wildfire. The night of the premiere was also the most frustrating night of my entire life. Ronald W. Milam Jr. and I literally almost threw my Mac across the room, and indeed my mouse was broken at some point in a fit of rage. In a red carpet event that was supposed to be as life changing as puberty (come on, we're rappers now!), technology reared its ugly head and bit us both in the ass. Our night was only saved by a bottle of Yellow Tail Cabernet Sauvignon and by removing the Outro from the DVD for the evening. We were an hour late to the Carrboro Arts Center, as I ran across Rosemary Street, clutching my 20'' Mac desktop in my arms.

Before you go any further, here is the YouTube link to this instant classic. Behold the pure genius of Whitelightning and Ro-licious. Behold longevity and immortality. Behold 5 Star Nerve:

http://www.youtube.com/watch?v=fXTyUTMv0Oo

Ronnie and I had successfully finished the video a day ahead of time: Intro, Outro, sound effects and everything. All we had left were the Credits, and a possible showing of the Outtakes. Eight o'clock in the evening was the start time, and by around 5:30 we were good to go. We scrapped the Outtakes (to be shown at a later date - people have to have some reason to buy the DVD, right?), and at six pm we burned our first copy. I ran downstairs to play it on the big screen in crystal clear High Definition (only the best for our MS1s), while Ronnie got ready to burn another copy and upload it to the net. The plan was to burn 2 copies, one for back up, and then publish it to YouTube as our diaper. With two hours to go before showtime, it wouldn't even be close to a photo finish.

And then all hell broke loose.

Six minutes into an 8 minute and 42 second video, the audio went completely awry. The sound from a clip 20 seconds down the road started playing completely out of sync. Nothing made sense. Ronnie heard me yell, "Oh SHIT!" from downstairs, and he knew our night had just begun. Immediately, we went into troubleshoot mode (Ronald was much calmer than I was - he had to answer all my phone calls because I was too irate to participate in rational conversation). The problem was that the video played perfectly in iMovie. Only when it was formatted did the thing start going screwy. Perplexed and vexed, we proceeded to call Apple, call our class presidents, push back the time we would be getting there, have someone (thanks, Krissy!) buy a cable at an Apple Store for a backup (hence the reason I was running across Rosemary with a large desktop in hand). For three hours we tried to fix this epic and utter disaster. Fortunately my mouse was the only causality of the whole operation.

Eventually we had to completely scrap the Outro. The students, as you saw in the video, would learn the brachial plexus, but they never found out their grades. Whitelightning never got a 37%, and the video went straight to credits. Disheartened and severely frustrated, we finally got a version that worked and hopped in the car. We sped down 54 and through campus, parked illegally, and zipped across oncoming traffic to deliver the DVD. We were welcomed with cheers and flowers, and the 5 Star Nerve (the shortened edition) was played to an enthusiastic medical crowd. Of course, the left speakers weren't working, so a couple opening lines got dropped (why not? Technology had already completely failed us). Ronnie and I left immediately after, too disappointed to stay for the rest of the night's scheduled events.

The MS1s won, but we were on edge. It was a high intensity night, and our relief became vegan White Russians at Kelly's house. We didn't get to see any other skits (even the medUNCedoos’ version of Empire State of Mind by Jay-Z - of which I rewrote the lyrics to Med School State of Mind). It seemed like the 6 hours of video, cut down to 9 minutes, with hundreds of man hours (literally, not kidding, hundreds), and dozens of classes missed, had all been a waste. It was the most anticlimactic moment I've ever experienced.

Fortunately, all has been rectified. I spent an hour on the phone with Apple yesterday (the file was corrupted, we had to completely retool the part, save it in a Quicktime movie, then reinsert it), and, as of midnight last night, the movie was debut. Stephen Vance gets credited with the first ever viewing, and I'm sure his autograph will be worth something someday. Or perhaps he'll make it to Oprah. As of right now, the video has over 300 hits, and that's just within the first few hours. Our goal is a million; this video will take over the world. Clearly it deserves 5 stars...

Yo Gotti, we will be expecting a call from you soon (hopefully not to sue us, just to recognize our genius).

Now that's a 5 Star Rap about some 5 Star Nerves!