Tag Archive | anatomy

Med School: US vs. India

I found an interesting article on Medscape, titled “Inside India – The Path to Becoming Doctor”:  Click Here

It got me thinking about my recent summer experience in India. The article pretty much summed up the stark differences. A mere first-year medical student, I learned from the doctors there how their medical training was like.

  • Entering medical school is based completely on entrance exams – No traveling expenses, no interviews, no need for lists of extracurricular activities, no questions about your motivation for becoming a doctor, no personal essays, no criminal background checks, no die-hard & extensive application process. In the US, the applicant is under insane stress, from taking the daunting MCAT (Medical College Admissions Test) to conducting revolutionary research to passing the interviews. I clearly remember the last years of college dedicated to research, volunteer work, and academics. After the grueling MCAT trials, I wrote textbooks of personal essay drafts, a general one and supplemental ones that were school-specific. Finally, I completed all the components of my AMCAS application, assuring myself everything was perfect to the bone. Then, I prayed for interviews, the final leap into medical school. And a reason to shop for nice business attire and take a break from school to travel, from Niagara Falls to Chicago.

  • Medical school begins right after high school – Which means, I’d be a doctor already if I were in places like India. Or China and Taiwan.
  • Just over 5 years of training and you have your MD – Yep, I’d be a doctor at 22 already, and not 26. That’s not including at least 4 years of post-graduate training =/ At least in the US, medical students come from an array of backgrounds. Four years of undergraduate studies and college life allow for diversity, maturity, exploration, and fun, because medical school is a serious commitment. It will become a trial of endless studying hours, exams, and clinicals. For me, I had the best time at NYU; I loved the social scene, the vibrant city life, and my friends. As much as I worked hard in the laboratories, the classrooms, Bobst library, Palladium gym, shopping in Union Square, or running down Broadway for class, I had fun and also wanted to get a job. I balanced multiple student jobs, and I wanted my first real pay check. That would only come after another 10 years under the institution known as medicine. I am falling into the smaller and smaller percentage of students going straight to medical school after college. More and more are taking time off to do research or volunteer work. I managed to do everything I needed to do during college; I was ready for the next chapter. I have more personal growth to do still, as I find myself naive and innocent many times. And I don’t think I can imagine myself beginning medical school at the virginal age of 17 … That really is young. To conclude, while I would like to be a sprouting doctor at a young age, I am happy with the American system of medical education.
  • Classes are mandatory – The surgeons and doctors in India laughed when I told them classes aren’t compulsory. For first year at Stony Brook, only Biochemistry and Anatomy were mandatory. It was frenetic, coming in early and sitting through stupid Biochemistry clicker questions. Then the afternoons were Anatomy lectures and dissections, which usually did not end until 5pm, or even longer depending on review sessions and pinnings. The rest of the year, because classes were not mandatory anymore, people started disappearing and snoozing at home. Still mandatory were Foundations lectures, which were the “How to Be a Good, Compassionate Doctor” lectures. They were entertaining and relaxing, for I mostly lounged on the Internet =) I became a victim to my demons, sleeping more than studying. I attended lectures here and there, when I felt motivated, which was most days. Second year will unleash my worst demons; apparently, lectures are not as organized or interesting, and of course, not mandatory. I’m seriously contemplating on self-studying at my leisure next year and skipping early classes. And also fitting in work, gym, TV, dramas, and food. I’ve already bought simplified, review-type textbooks with silly pictures and mnemonics and notecards for Microbiology and Pharmacology, the killer classes of second year, aside from more Pathology. Yay =/ Oh yea, and there’s also the looming shadow known as the Boards.

Oh Boy... I need picture books for med school

We Got Married (Korean reality) - All 100++ episodes (and ongoing), and more Asian TV =/ Bad distractions...

  • Lucky ducks, clinicals start 2nd year – At Stony Brook at least, clinical rotations start 3rd year. American medical schools offer electives, specifically catered to students’ personal interests and endeavors. India… no electives. They’re missing out on the interesting stuff…
  • On anatomy dissections and cadavers – Where do the bodies come from? Are there donation programs and anatomical gifts? The flashing answer is no… Back to the first question, then how do students in India learn anatomy? Well, according to the doctors there, cadavers come from unclaimed bodies of beggars usually. India’s culture and religion values keeping the whole body intact for journey into the afterlife. Same idea in most Asian countries. There’s no benevolence in donating one’s body for the name of scientific research. There’s only the grief and wish that loved ones have a safe trip into the next life. So in India, the police turn over dead bodies found on the street. I think back in the old days, there were also grave robberies, like in the US during the 19th century. Perhaps it still goes on now too. Either way, there’s a shortage of cadavers for anatomy dissections, so normally 20+ students take turns on a single body. At Stony Brook Med, we have tight-knit groups of 4 students per body, while at some schools like Buffalo, it’s more like 8, the capping limit. Here, the learning is more interactive, as everyone has a chance to be up close with a scalpel and dig through fat.
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An Anatomical Gift

The anatomical gift:  would you donate your body to medical schools for education and research?  Now, would I donate my body, knowing how invaluable the introductory anatomy experience has been for fresh medical students? After learning so much about the human body and functions from methodical dissections, I am grateful to the people who have given their bodies to science. I still cannot stomach to think about the cadavers as people like you and me when they were alive. They have families who miss them. They used to have jobs, talents, feelings, reminiscent childhoods, college sweethearts, favorite foods and flowers, amusing memories, etc… they were humans. Most lived a full life, up to 80s and 90s, though the end was likely wrought with sadness and suffering.  From the inside, we saw the physical damages brought on by cardiovascular disease, pulmonary failure, stroke, and cancer. Tumors gnawed away at lungs or the colon. Pulmonary embolism, huge pulmonary vessels, and hyperplasia, all contribute to severe pulmonary disease. A rock-solid thoracic aorta, likely from plaque-build up, atherosclerosis, and hypertension.  The physical deterioration of the human body is inescapable and only a natural procession through life.

Back to my original reflection, would I donate my body? Personally, no, for religious and cultural reasons. In Chinese culture, it is believed we pass onto the afterlife with our bodies intact. If bodies are opened and parts tampered with, then the soul and spirit have been contaminated. Whether it’s traditional burial or cremation, the body needs to be whole.

I wonder if people know what really goes on in the laboratory, whether they and their families have been fully informed of their decisions. They may only see the unconditional glory in donating out of the goodness of their hearts for medical science and research, and not what happens to their bodies physically. At the end of their lives, the sick patients seek to pass their sufferings and escape to a better place.

Regardless of my personal proclivities, I am thankful to the people and families who gave the gift of knowledge to us. Currently, I am aboard the committee planning for the upcoming memorial ceremony in honor of the donors and their families. I am excited to be a part of this collaborative team in making this a memorable and meaningful experience for students, deans, families, friends and the community. This is really the first time I’m taking on a leadership role this significant and poignant.

What I Hated the Most?

… The pelvic region and the posterior end. No one liked the pelvic region. There’s too much going on down there, front and back, in too small of a space.  Crus of the *&^#@, arcus tendineus, mesometrium, mesovariam, any reproductive organ with the attachments “ischio,” “bulbo,” or “cavern”- I prayed I wouldn’t have to identify any of those ambiguous parts on the lab practical.

I’m a girl, what more can I say, but I ended up learning more about the male parts way better than the female’s by default of the man-cadaver we had. Ironically, 3 girls and a guy, I wondered if it hit a little too close to home when we studied the male anatomy. Also, when I hitch a ride home late at night, I swear I’m going down a big, dark corpus cavernosum. The quiet, black street feels eerie and endless, like a deep cavern. I must clean up my head of anatomy…

 

I hated the lower back region; everything looked like a cavern in there. No matter how deep I burrowed my head, ready to tip over with one push, I failed to distinguish the lumbosacral trunk from the obturator artery. The uterus looked like a shriveled balloon. The penis became black and hard like charcoal. The gluteus maximus was a greater battle, because layers of fatty fascia had to be pulled out. Even after that, I was still looking at the butt. Not a very pleasant view to study.

I’m thinking, if only I spent more time enjoying, dissecting, and learning the behind, maybe I could have stomached watching the surgery in the 2009 Dutch movie “The Human Centipede.”

Anatomy: A Beautiful Disaster?

The most memorable anatomy moment?  Definitely the exploding rectum episode.

My labmates and I were finishing up the abdomen. The beginning and ends of the intestines were tied off, but not tight enough. After we cut out the intestines, we realized (and smelled) our boo-boo: the rectum was not completely tied off.  Needless to say, the contents exploded when we proceeded to open the pelvic region. To supplement the horror, our cadaver had a larger-than-normal rectum. His feces were not even solid; they were “fresh,” soft, and rather stinging to the nose. All I thought was, “Did he go to the bathroom at all?” While the four of us could only cry from the putrid smell and “Uhhhhghhhh” around the table, our brave TA of the day, Stephanie, dared to whip out her scalpel and battle the messy rectum. Boy did she emerge victorious and scathed after nearly an hour: the greenish-brown oils and stains, all down her white coat, sleeves, and gloves. By victory, she removed the rectum and ruined some tissues and vessels nearby.

The rest of us were useless, grimacing spectators. The most we could offer to do was wipe away the mushy mess and dump water to dilute and mop up the wreckage. The rest of the time in lab, we continued watering down and staining more paper towels. I swear the smell followed me for a good week after that encounter, but none of us had it as badly as our heroic TA. Well, we promised to give her a very positive evaluation for Dr. Stern =)

Gross Anatomy: The First Patient

First year Gross Anatomy has come to a blissful close.  Throughout the semester, I’ve been drowning in anatomy.  I’ve been floundering in anatomy jettison: weekly entertaining lectures, down & dirty dissections, quizzes, the big midterm, embryology, lab practicals, and an even bigger final exam.  Now that my 3-day marathon of exams for this one class is over, I feel… liberated and triumphant. Well not quite yet, I still need to know my grades.

At Stony Brook, the class is termed “The Body,” like supermodel Heidi Klum’s sexy nickname. Except, the class is not at all sexy or like a glamorous Victoria Secret’s runway show. When I first started the class, I felt like I was walking through a horror movie. I tend to be squeamish, only recently getting used to the sight of blood and body parts. Hey, if I chose the medical path, I have to be a brave soul.

Walking in that first day, I panned around the fluorescent-white room to see a sea of white body bags. Scrubs on, hair up, scalpels ready, we began to unzip. Inside, a freshly-preserved human body awaited the first cut. The first dissection- the back muscles and spinal column. Glad I did not have to look in the cadaver’s face yet, I twitched at the slightest touch and yelped when bits of flying flesh hit me. Methodically, I peeled back the flap of skin and let the scalpel shave through the flowery fascia. At first glance, it looked like we were trapped in a sick movie scene, with all the 1st-year medical students slicing away at tissues and hacking away at the vertebrae like lumberjack carpenters. And yet, we all have the remarkable opportunity to delve into the human body to see the beautiful interplay of vessels, organs, musculature and pearly aponeurosis.

Oh, the many anatomical sketches I’ve drawn. Never have I enjoyed so much coloring and doodling since kindergarten and elementary arts & crafts. In preparation for lab and personal perfectionist tendencies, I have belabored over countless drawings of organ systems, muscle relationships, circulatory networks, and nerve pathways. It’s almost like embarking on a road to become medicine’s next top Netters. However, the man is just too talented, his drawings are absolutely legendary, and I can never dethrone the master of paper and syringe.

Anterior Thoracic Wall-My doodles

Netter's Anterior Chest Wall-See the difference?

Let’s not forget those endless hours glazing over the Netters’ atlas, especially when it came to studying the difficult pelvic region. I felt a little embarrassed studying a rather private area in a very public library. I also wonder who modelled for Netters when he sketched the naked macho-man flexing his biceps brachii and pectoralis major…

"Smell my neck"

To conclude, this is how I studied for my crazy finals. That weekend, I chilled in my room, freezing and freaking over the impending anatomy exams. The weather was terrible just by hearing the cries of the wind and tree branches whiplashing the icy air. I lounged on the living room couch, memorizing answers to old exam questions. That was not at all comfortable, because I was practically sinking into the couch. The next day, I migrated to my bed. $Bad idea$ You would think I learned my lessons from college, when I used to be lazy and study off my bed. Next thing I knew, I woke up at an awkward hour and still have a whole binder of notes to study before that day’s midterm. That’s why I always forced myself to either 1) stay up all night or 2) study in a stimulating environment, like libraries or Bobst. Now, that’s more difficult because 1) I live off-campus, 2) I do not have a car, and 3) it’s Stony Brook and nothing is within walking distance except the parking lot and Waldbaums.

So I camped out under my covers all day, bundled up in a sweatshirt and yoga pants. I felt like a catepillar in a cocoon. Aside from food and bathroom breaks, I was like the Energizer Bunny high off Chinese green tea. My bed was littered with diagrams and notes, Netter’s Atlas, and Stern’s Core Concepts & Clinical Sidelights. I spent a whole Monday staring at pictures of the head and neck, driving into my head every cranial nerve function and pathway. Oy… why did the facial and trigeminal nerve have to be so complicated? I should not be complaining, because technically, I would not be smiling or furrowing or feeling a titillating cheek rub without them.

Well, as it may have been guessed, I fell asleep next to Netters and Core. By around midnight, I started feeling drowsy and sleepy. I still had loads to study, but I told myself, “Okay, set an alarm for 4 am, wake up, and study some more when you feel refreshed.” That was not a realistic goal at all, because I kept sleeping. I woke up at 4 am, looked at a few questions, then flopped onto my pillow again. Then I woke up at 6 am, only to study for barely 5 minutes and fall asleep again. I did not actually pick up my lazy tushy until 10 am, when I finally found my focus. Well, by then, I felt more screwed than prepared. For some reason, I still can do well under pressure and cramming the morning of an exam. I believed in myself. The same episode happened again the next night. But hey, at least I got my sleep =)

Lessons Learned

December 17: Last day of anatomy lecture was rather memorable. Dr. Stern saved the best live show for the finale – “Gait Disorders”

Superior gluteal nerve & the Trendelenburg gait

The gluteus medius and minimus are thigh abductors, thus preventing the opposite thigh from dropping inwards during the support phase of gait. For superior gluteal nerve damage to the gluteus medius and minimus, Dr. Stern demonstrated a bilateral Trendelenburg gait. If you stand on the affected leg, the opposite pelvis drops; to compensate, the trunk laterally flexes to the weak, unsupported side. If there’s a bilateral damage, you look like you’re swaying some sexy hips for Project Runway.

Dr. Stern flattered the class with a caveat: “You will see a case of a person with bilateral Trendelenburg gait. I’m going to show you the bilateral Trendelenburg. But you have to promise not to fall in love with me.” [class chuckles] And then he goes on to pop his pelvis for an anatomy runway show =D I wish I could post the video lecture, but it’s not for public viewing outside of the medical school.

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

My dad walks with a limp, so I believe he has a Trendeleburg gait. He had polio when he was a child, and he suffered nerve damage to his upper thigh region. His whole left thigh is atrophied and practically useless, so I think multiple muscles are affected. One day, I had my dad walk back and forth for me in the cold, but I could not accurately diagnose the Trendelenburg gait because his clothes were too baggy. The Trendelenburg test asks the patient to stand on one leg and see if he or she drops the opposite hip. For my dad, he cannot stand on one foot without tipping, so that may be a “positive” test. I did not want to be mean and push his hand off my chair when I asked him to do it. That way, I’d get a definitive result AND be a cruddy daughter.

I do believe he has inferior gluteal nerve damage because he cannot walk up the stairs without support. That means, he has paralyzed gluteus maximus, the ‘ass muscle,’ in which he cannot properly extend his thigh. Normally, the gluteus maximus has a small role in the beginning of support phase in gait, controlling for the tendency of the trunk to jack-knife forward at heel strike. When he walks, I’ve been noting a slight backward lean to compensate for the loss.

Sciatic nerve and the Buttocks

The sciatic nerve looks like a huge, white bundle running down the posterior compartment of the thigh. As my professor terms it the “phony nerve” because it’s really 2 nerves running together like Hansel and Gretel. The common peroneal and tibial nerve branch near the back nook of the knee, adorably named the ‘popliteal’ fossa. The sciatic primarily innervates the hamstrings (long head of biceps femoris, semitendinosus, semimembranosus), producing knee flexion and thigh extension.

The sciatic nerve can be damaged in the gluteal region, commonly known as the “ass,” in rather compromising positions.

(1) Sitting for a long time wedged in a toilet seat.

Dr. Stern: “My wife kills me when I mention this. But, you know, I like to sit and do crossword puzzles… I urge you to do it sometime…. You will feel it when you start to get up. You will feel pins and needles all along the distribution on the sole of your foot and most of your lower leg and you will walk all wobbly.” [professor wobbles forward]… “It’s worth experiencing.

(2) Prolonged sitting on a thick wallet, what I call the “fat wallet syndrome.”

Dr. Stern: “It’s going to be a problem in years to come… when you become physicians.

(3) bicycling, cello playing, anything that numbs the butt

“Ohm” the Peroneal nerve

Common peroneal nerve can be damaged easily because it runs laterally down the lower leg, after it parts from the sciatic nerve at the popliteal fossa. External pressure from plaster casts, lithotomy support, and the lotus position can compress the nerve.

(1) I’ve never had a broken leg, so plaster casts have not been a big deal. But if you’ve broken (or will break) a leg, just remember your common peroneal is at risk when your leg is taking a little plaster vacation.

(2) What are lithotomy positions? Well, it’s mainly for pelvic and lower abdomen surgeries. It involves laying supine, knees bent, and legs up high and spread apart in stirrups, not too much different from a visit to the gynecologist or childbirth. It’s awkward and uncomfortable; no one likes to feel helpless and exposed in that manner. As if that were not enough, the femoral nerve running down the anterior compartment of the thigh (quadriceps femoris: rectus femoris, triplet vasti muscles) is also at risk of injury.

(3) I love yoga and pilates since beginning in college, and the exercises involve bending my limbs at funny angles and constantly working new muscles and particularly my breathing. Well, apparently the meditating lotus position can have negative reverberations from compressing the lateral side of the leg. Plus, I’ve finally understood why my legs went numb when I sat Indian style during elementary school story time. The numbness would first settle in, then the sudden pins & needles left me paralyzed for a good 5 minutes- painful and annoying. I’d have to sit like a block of wood until the sensation subsided. After all these years, now I know. I wonder how the Buddhist monks do it in the mountains…

(4) OooO now I also know why crossing my legs for barely 5 minutes causes tingling spasms, like when I sit Indian style. I’m a girl and I like to cross my legs in a lady-like fashion, but it comes with an annoying price: more pins and needles. Ouch. Well, the reason is because the common peroneal nerve travels rather superficially over the head of the fibula bone near the lateral side of the knee. When my leg crosses over, I am hitting the nerve; that’s why I need to constantly switch legs to relieve any pressure.

(5) This is a funny one, “Strawberry Picker’s Disease.” Conjure up in your head an old hunter and gatherer squatting down and moving swiftly like a monkey, picking up berries and bugs to eat. Well, not quite that barbaric, but you have an idea. The strawberry picker is crouching down and collecting fruits. It appears like an innocent, fresh outdoor activity, but the hamstrings tighten to keep the hip extended and the biceps femoris tendon compresses on the neck of the fibula where the peroneal nerve lies.

Molecular Happiness

Crunch time

It’s finals season, the same frenzied cycle as undergraduate. The last few days have been hectic:  long and cold nights of cramming wacky cell signaling molecules and disturbing genetic diseases, shutting myself in the library surrounded by fobby undergrads, getting hooked to cappuccinos and Lipton-based milk tea from the physician’s lounge, feeding glucose to my noggin at awkward times of the day, and just stressing out for a simple PASS. I’ve been getting my sleep, until a few days ago when I realized how little time I have left for the avalanche of topics I need to study and review. Two days ago, I slept for 3 hours, and that was miserable. In college, I usually felt fine on study marathons and pulling late nights, maxing out with 3-4 consecutive nights of minimal sleep; I just caught up on my sleep after the big exam. However, this week, I barely lasted a day, because the next day, I felt fatigued. Last night, I had a disjointed sleep session, taking a much-needed nap that lasted 2 hours and struggling to keep my eyes open until 3am when I was felt at little accomplished for understanding ADP-ribosylation in cholera and pertussis toxins. Being sick amidst finals is no walk through a blissful dream; my brain felt like gooey pudding.

Early this morning, I was still cramming last minute before my afternoon exam. I’m realized I never feel ready for exams, using ever minute possible to stuff important facts, just in case they come in handy; it works like a miracle in bygone days. Nucleotide metabolism, check. Autosomal dominant diseases like osteogenesis imperfecta and Marfan’s, double check. Receptor tyrosine kinases and Jak-stat pathways, oy! Cancer, DNA replication, homologue recombinations, holiday junctions and chiasma, ooph! Imprinting and epigenetics, oh lala… Antibiotics that do battle with prokaryotes, rock on!

Nap time

The computer lab was an oven, more than just an easy-bake oven; I felt like baked chicken. Maybe that’s why I got dizzy in the middle and started nodding off. I told myself, “Okay, at least make it halfway through your 100 multiple choice questions, and maybe you can snooze.” I ended up zipping through all 100, marking a bunch that I did not feel like pondering at the moment. I fell asleep a few times during my test. My mouth felt dry and my eyes kept drooping; the levator palpebrae superioris was not doing its job. Seriously, what kind of model medical student am I when I can barely stay awake during a major exam?! I took a ‘bathroom’ break and dashed to the physician’s lounge for a quick cup of hot coffee to wake myself up. I came back, full throttle, and went through the exam 3 times before my time expired =)

Then, a surprise email from my professors; we all passed! During an anatomy review session, someone in the class read the email and shared the happy news. I checked my grade later, and once again, I did about average. Average for the exam was 85; on the midterm, it was an 88. I have a tendency to miss the mark, so nowadays I’m just an average student. I’m content; I’ve accomplished so much through college and now I’m in the final years of schooling. Numbers and A’s are not as important as they were for me in high school, since the pre-med mentality through college and a blooming social life mellowed down my fire. All I want to do is learn and do what I love- work in health care and heal sick people.

Right now, I’m drained. My mind is still swimming with genetic diseases. They are so interesting to learn, and yet, frightening. I appreciate my life, because 1) I’m thankful I’m not a mutant, and 2) so many things can go wrong at the cellular level before birth. Yes, mutations are rare, and that’s why we have complicated, well-regulated mechanisms to combat mistakes. We are typically born healthy, but we are error-prone and anything can seriously happen, at any time.

Boom

Programmed cell death, or apoptosis, is just as essential as cell growth in life. Mutations occur all the time, but with all the cellular checkpoints during replication and repair pathways, we bypass the harmful effects and disease. Many diseases lurk in the depths of human biology, and I only learned a handful (okay, 2 inches of color-coded index cards). Fragile X, Neurofibromatoses, Cri-du-chat, Down’s, Patau, Edwards, Marfan’s, Turner’s, Kleinfelter’s, Lesch-Nyhan syndrome, etc… it’s mind boggling to learn all the inheritance patterns and the molecular intricacies of each disease. What’s scarier is the fact that quite a bit of diseases result from spontaneous, or “de novo,” mutations. Once it happens, it’ll be inherited. And genetics is rather complicated, more than just Mendelian dominant vs. recessive. Let’s take autosomal dominant disorders are characterized by variable expressivity (the degree of symptom manifestation), incomplete penetrance (all or none phenotype when you have the genotype), high recurrent mutation rate, and late-onset. Then there’s imprinting, or gene silencing, mitochondrial inheritance, mosaicism, and trinucleotide repeat expansion with anticipation (the more repeats and subsequent generations, the more severe and the earlier onset of disease). I’ve only wet my feet in a puddle so far, but I also feel more like a doctor.

Eh, I change my mind… I feel more like a zombie right now. I’ve been fortunate enough to be sick the entire week, sneezing and wheezing. My nose has been bipolar, running one moment and clogging up the next. My sinuses have been filled with mucous, which shouldn’t happen in the first place because infections can spread and drainage is blocked; naturally, we are airheads as our head has many holes and passageways for draining and neurovascular bundles. I hate popping drugs, so I let my T-lymphocytes patrol my bloodstream and kill the invaders of my immune system. Throbbing headaches have been tiring me out, particularly the sinus ones that emanates from the occipital region. When air goes up my nose, there’s a fuzzy, sharp pain entering the back of my nasal cavity. Breathing never felt like such an effort, except maybe during yoga.

Now, 1 final down, 3 more to go… FOR ONE FREAKING CLASS. It’s the bane of my existence, a medical school horror show called Gross Anatomy. Three more exams: lab, written, computerized.  I’m taking a breather today (yes, my nose has recovered its function). I’m going to sleep early after this late-night blog. I’ll wake up tomorrow, go to the gym, and kick some final ass at anatomy =)