doc w/ Pen

Note: This post was written 5/29/2010, while I was on a plane on my way to Hawaii. I had no Internet access on the Big Island, so I am just now posting this.

In no time at all, I launch my official pre-med journey.

T-minus 3 months … 

Yes, that “3 months” refers to the beginning of school. Hard to believe that in a short 90 days or so, I’ll be a student again, after a 7-year stint as a grown-up.

So much feels the same, and yet, so much has changed.

I have yet to finalize my course load — so far I’m registered for Chemistry, Biology, Calculus, and a 1-hour “Topics in Medicine” class (it’s a requirement for me). I’m also trying to get into Physics, which my advisor has assured me will be a non-issue. That would put me a 17 hours – a pretty heavy load for someone who hasn’t been a student in nearly a decade. So I’m in the middle of a debate with myself: do I take all of these classes? Take Physics next year instead? But I’ve heard taking Physics with Organic Chemistry (a so-called “weed-out” course I have to take in the 2011-2012 school year) is a nightmare. Then there’s the issue of my wanting to take as many of the “fun” upper-level electives as I can, which means getting the basic pre-requisites out of the way ASAP. *sigh*

This reminds me of when I was preparing to start my freshman year in high school. The debate then was whether to take a 2-hour accelerated science course, or just take the 1-hour basic (in my mind: “dummy”) science course. I remember being at my grandparents’ cabin in Colorado, sleeping on the pull-out bed and obsessing over this dilemma. (In the end, I took the easier class because the harder one just didn’t seem worth it; plus it didn’t fit in my schedule very well. It turned out to be a good decision.)

However, this time around, I am not obsessing. Actually, I am very calm. My approach? Sign up for all the classes, start off the semester, and see how things go. If the classes are too much, I’ll drop one of them before the “drop” date and no one will be the wiser.

In these 15 intervening years, between the ages of 13 and 28, I have learned to have faith in myself, and in my decision-making abilities. I am more flexible. I have learned to handle change. I believe things will work out, and work out well. The thought of the unknown, of uncertainty, does not leave me panic-stricken.

Some things stay the same. Thankfully, other things do change.

Note: This post was written 5/29/2010, while I was on a plane on my way to Hawaii. I had no Internet access on the Big Island, so I am just now posting this.

Large “Red Eye” (coffee plus a shot of espresso), room for cream. That’s my usual order at Descartes Coffee, the coffee stand in the University of Illinois at Chicago Student Center. Just across Wolcott Street from the Medical Sciences Building where the lab is located, the Student Center is a hopping spot at lunchtime for medical students and other UIC staff and faculty. I don’t usually talk to anyone there – other than Eva, who staffs the Descartes stand – I just watch, and listen.

You can tell a lot about a person at UIC by what he or she wears. White coats, for example, inside the lab building suggest a researcher or PhD student. The same coats worn outside the lab usually denote medical students (short coats), residents (medium length coats) or attendings (long coats). A stethoscope around someone’s neck is a dead giveaway — definitely the medical variety.

I visually size up the length of someone’s coat, try to catch what his or her sleeve patch says (“House Staff,” for example, or “Medical Student”). Without drawing attention to myself, I try to lean in to hear what the people at the next table are talking about — an impossible gross anatomy exam? A grueling surgical rotation? A demanding attending?

People often complain over lunch (which, in the Student Center, usually consists of a Subway sandwich), griping about this or that to fellow students or colleagues. But I soak it in. I dream of the day when I will be in those shoes, groaning about that exam, rotation, or attending. I probably won’t think so at the time, but from where I am now, being able to complain about such things seems like a privilege.

OK, maybe that sounds stupid, and Pollyannish. Although really, when it comes down to it, I’m not exactly your sunny optimist type. But when you think about it, just getting into medical school is a long haul. And once I get there — and I will get there — I do not plan to take it for granted.

Catenin … adhesion junctions … cadherin … p120 … tyrosine … kaiso …

I stared blankly at Dr. David Wei, who was presenting the latest research on, well, um, I think it was about the role of a protein called p120 in the “adhesion” of cells – their ability to stick to one another. Yeah. I’m pretty sure that’s what it was about.

Olga had invited me to the weekly Thursday lab meeting. I was thrilled to be included. Rich Minshall (the lab director) introduced me to the other half-dozen or so people I hadn’t met yet, and asked me for a summary on what I’d learned so far. Everyone seemed impressed with the depth and breadth of what I’d accomplished in a mere three weeks. So far so good.

And then David began his presentation. Nothing against David – he’s an incredibly talented, intelligent anesthesiologist and budding research scientist. But he could have been speaking Greek as far as I was concerned. And the slides he was showing looked like hieroglyphics to me. I simply don’t know the language of laboratory science.

Slowly, as the 45-minute presentation went on, I began to catch on – a few words here, a concept there. By the end, I had a vague idea of his main idea. And I had picked up some new words along the way.

I’ve been in foreign language contexts before. In college, I studied abroad in South America (although I am nearly fluent in Spanish, so that isn’t a particularly good example). A better example: In high school, I went to China for a school trip. The words, spoken and written, all around me bore absolutely no resemblance to the language I had grown up with. It was humbling. To have to ask lots of questions, to have to learn from the ground up, to have a hard time saying “hello” because of the use of intonations (vocal inflections), which we don’t have in English.

My dad has told me over and over that the first two years of medical school are basically spent learning a new language: the language of medicine. I got a small taste of that Thursday. A flood of technical language, technical diagrams, the expectation of rapid absorption and understanding of new material. There will be no coddling, no hand-holding, no “let-me-spell-this-out-for-you.” Catch on, and catch on quickly, or you fall behind every more quickly.

Fortunately, I have a gift for languages. When it comes to grammar – whether it’s Spanish verb conjugation used in conversation, or Latin prefixes and suffixes used in medical terminology, I am quick to grasp the concepts. I also know how to memorize: vocabulary (words and phrases), linguistic rules, and exceptions to those rules. This is how I breezed through high school and college Spanish, and through a semester in Chile living with a Spanish-speaking family. This is also how I will learn to communicate in medi-speak.

And one of the greatest things about working in the lab right now is that it is proving to be sort of an immersion experience, which is, really, the best way to learn a language. I am exposed to terms, concepts, processes, substances, etc. that I have never encountered before. I hear about them over and over. Sometimes someone will tell me, specifically, what a particular thing means or does. Other times, I have to figure it out on my own, over time and through numerous exposures in different contexts.

Basically, it’s the Montessori method: experiential-based, curiosity-led learning at one’s own pace. And it’s joyous.

Lung fibroblasts (pictured above) produce the “food” our lung epithelium cells need to survive, as I learned this week.

A few days ago, Olga told me she’d thrown out a flask of fibroblast cells. What?! I couldn’t believe my ears. Didn’t we need those cells for … um … something?

Every day, I learn new techniques. But sometimes I get caught up in the “doing” and miss the bigger picture. Monday, though, I got some clarity. The “doing” and the “bigger picture” came together.

Olga and I are taking care of two types of mouse lung cells: fibroblasts and epithelium. Up until Monday afternoon, I couldn’t keep them straight.

Monday morning — before the clarity — Olga had me work with 10 plates (round plastic dishes) of fibroblasts. For five of the plates, Olga instructed me to aspirate (remove) the high-calcium media (liquid they grow in) and pipette in low-calcium media. Simple enough. Aspiration, pipetting, easy stuff (which feels really good to say!). I wasn’t quite sure why I was replacing high-calcium media with low-calcium media, but Olga was busy setting up another experiment so I went ahead with her instructions.

Once I was done with that, Olga told me that we were going to “passage,” or split, the other five plates into 10 plates to give the cells more room to proliferate. Basically, we wanted them to grow more, and they needed space to do that. That’s all well and good, but I wasn’t quite sure why we needed so many fibroblasts … we already had a lot, and had more in the freezer; why keep so many in the incubator? A question for later, I decided.

The first step in passaging the cells was aspirating their media. Then I washed the plates out with PBS, a sterile buffered saline solution, to remove any traces of serum from the plates (serum is one of the ingredients in the media). After aspirating the PBS, I added a solution of trypsin and EDTA to the plates, one by one, to detach the cells from the bottom of the plastic plates. Trypsin is an enzyme found in the digestive tract, and it literally “digests” the proteins that help the cells stick to the bottom of the plates. Olga and I then waited a few short minutes for the cells to detach, then pipetted in more media to inhibit the trypsin (to keep it from completely breaking down the cells).

I then sucked up the cells with a pipette, put them in a centrifuge tube, and ran the centrifuge machine for a few minutes. The result was a tube with a “supernatant” – layer of light pink liquid on the top — and a “pellet” — solid collection of cells on the bottom. I aspirated the supernatant, leaving the pellet at the bottom (this is a bit tricky – you have to be REALLY careful not to suck up the pellet, because then you’ve lost all your cells and you’re screwed). Next step was to “resuspend” the cells in new media and divide them into 10 plates (remember, we started with five, so we’ve doubled the number of plates). Because they have more space, the cells will spread out and grow more until they reach “confluence” – saturation.

OK, I get all that. But why did we do all of that to the fibroblasts? And what about the epithelium?

Olga explained: we want to grow as many fibroblasts as possible (hence “passaging” the fibroblasts from five into 10 plates so that they will proliferate more) because fibroblasts produce the “food” that epithelium need to survive. And the epithelium are the cells that we are interested in looking at, from an experimental point of view, but we can’t cultivate them without also growing fibroblasts.

Basically, when you put fibroblasts into low-calcium media (as I did with five of those plates Monday), the fibroblasts produce what are called “growth factors” that epithelium need to live. Olga threw out those flasks of fibroblasts a few days ago because she had gotten what she wanted from them – the growth-factor-filled media to give to the epithelium – and the cells were no longer any good (i.e., capable of producing more growth factors).

Ah-ha. That’s why you ask questions. To discover the “why.” To give your activity context. To provide you with a goal.

Before yesterday, isolating RNA (schematic above) from cells seemed like magic.

Science isn’t magic. It’s, well, science. Hard work. Long hours in a lab. Sometimes tedious procedures done over and over. Often times, frustration. But hopefully, some meaningful results.

From the Latin scientia, meaning “knowledge,” science is the “systematic enterprise of gathering knowledge about the world and organizing and condensing that knowledge into testable laws and theories” (from Wikipedia.org).

OK, that’s pretty obvious. But when you don’t know how science works, it might seem a little like magic. Or at least, it has sometimes seemed that way to me.

But yesterday, Olga showed me how to do something that I never imagined I’d see, or have the chance to do (she wants me to try it for myself soon): isolating RNA from cells.

RNA stands for “ribonucleic acid.” RNA is similar to DNA (I won’t go into the structural differences; it gets pretty technical). RNA is very important for protein synthesis (making proteins in the cells), as well as for regulating which genes are expressed in a cell.

RNA is tiny, tiny, tiny, as you can imagine. Our mission was to separate these tiny nucleotides from the rest of the bits of a group of cells that we collected.

Before yesterday, this procedure seemed like magic to me – I had no idea how it was done, and I imagined it happening in a hugely high-tech environment with all kinds of machines and things. Lots of complicated stuff, way beyond my understanding and capability. But Olga and I (well, I watched) did it rather simply – with some plastic tubes, bottles of buffer solution, pipettes, a syringe and needle, and a few spins in the centrifuge.

Of course, understanding the mechanisms for how the RNA was being separated from the cell, and why we were doing it, is quite advanced. But the procedure itself was rather simple, in terms of technology. No magic here. Science: patience, time, and hard work.

The kit we used was called “RNeasy,” and was designed to make the process just that – easy. First you pipette your sample into a special tube, which contains a silica membrane that will eventually trap the RNA. Then you lyse (break down) the cells using a special solution. Then you homogenize (blend) the particles using a needle and syringe, sucking them up and squirting them out several times. Then you add ethanol to them to help them bind to the silica membrane. Then you use buffer solutions to wash away the contaminants, centrifuging in between the washes. The RNA is then eluted (extracted) using water. (At least, I think that was the order of things …)

Olga glided through the process with the grace of a professional ballet dancer. Of course, just remembering all the steps, properly pipetting (without contaminating anything), using the centrifuge correctly, and so on – much less doing it all quickly – isn’t easy for a beginner, such as myself. But I am slowly grasping these techniques, and building up speed.

Most importantly, I am learning the science behind science. And that is a lesson I will not forget.

Using a pipette: one of my first lab lessons.

I’ll be the first to admit that I know absolutely nothing about working in a research lab. Pipettes? I vaguely remember them from high school chemistry lab. Bunsen burners? I know they burn things (Captain Obvious), but don’t ask me to light one. Petri dishes? I know you grow cells in them, but anything beyond that is beyond me.

So it was with a humble heart and spirit that I entered the pharmacology lab at the University of Illinois’ College of Medicine building at 1853 W. Polk St. this past Tuesday.

Research lab positions are coveted among pre-medical students, as medical schools look very favorably upon them. But getting a research job – especially if you don’t have any experience – is a difficult matter. It’s a catch 22. Without any experience, you can’t get a research lab job. But you can’t get any experience unless you get a research lab job to begin with.

I, however, networked my way into this position. Several months ago, I decided to try and contact some local physicians and ask to shadow them. But if you ask just anyone – someone who doesn’t know you – they’re more than likely to say “no.” So I turned to my alma mater’s online networking group (kind of like Facebook or LinkedIn, but for UIUC alums) and messaged several Chicago-area MDs. One, a pediatric anesthesiologist named Dr. Richard Berkowitz, got back to me. He agreed to meet with me at his office in Munster, IN. We talked about medical school, residency, all kinds of things. When I asked him what I should be doing to prepare myself for medical school, he mentioned the obvious – community service – but also brought up research work. He put me in touch with a former colleague, Dr. Gina Votta-Velis, an anesthesiologist and researcher at the University of Illinois-Chicago. After meeting with her, and her research partner in pharmacology, Dr. Richard Minshall, they agreed to let me come on for the summer as a volunteer.

Tuesday morning, I timidly poked my head into lab E420, looking for Olga Chernaya, the post-doc researcher who is my supervisor (and mentor). Luckily for me, Olga is friendly, funny, gracious, and patient – and a good teacher.

But rightly, she was also a bit wary of having a completely untrained pre-med student poking around her cell cultures and taking up her precious time.

“Do you have to have your own project?” she asked me. Apparently, some students who come into the lab need to work on their own research project and write a paper about it within eight to 10 weeks – not much time to get much done, especially if you don’t have any prior experience working in a lab.

“No,” I told her. “My goal is to stay out of your way, to be helpful, and to learn as much as I can.”

“Wow, that’s rare,” she said.

The tension lifted.

From the beginning, Olga included me in what she was doing. That first day, Tuesday, we looked at her fibroblast and epithelial cells under the microscope. That might sound simple, but I hadn’t used a microscope in years, so even focusing the microscope was something she had to (re)teach me. I felt a little embarrassed, but her patience eased any of those feelings.

On that first day, She showed me how to use pipettes. She showed me what kinds of cells she grows in petri dishes. (We haven’t gotten to bunsen burners yet, but I’m hoping that will come soon.)

The second day, I got to try things for myself. I used suction to draw out the high-calcium media (the liquidy stuff cells grow in) from flasks of cells, washed the flasks out using pipettes and a sterile solution of DPBS (phosphate buffered saline), and then replaced the high-calcium media with a low-calcium media solution, again using pipettes and suction.

What would have taken Olga 15 minutes probably took me 45, but it was a learning experience. And Olga must have been satisfied with my progress, because she’s leaving for a conference Friday afternoon and she wants me to “babysit” the cells while she’s gone – replacing their cell media twice next week, this time all on my own, no supervision.

It feels like a huge responsibility. And I’m nervous. What if something goes wrong? What if I forget what to do? What if I break something? What if I contaminate the cells? What if I – gasp – KILL them?

Then I remind myself that she wouldn’t ask me to do this if she didn’t think I could handle it. And really, it’s not that hard, once you break it down: Suction, pipette. Suction, pipette. Suction, pipette. Suction, pipette. That’s basically it (and try not to contaminate anything while you’re doing it).

Someone else believes I can do this – this is an opportunity for me to practice believing in myself, too.

When I was in high school, it was practically a mantra: “Take A.P. Take A.P. Take A.P.”

This referred to Advanced Placement classes, designed to teach the same concepts as a first-year college course. At the end of the school year, a standardized exam was offered to test your proficiency of the material. Based on your score (on a scale of 1 to 5, with 5 being the highest possible), you could receive college credit for the course.

Those of us students on the so-called “honors” track heard this mantra from teachers, guidance counselors, parents, and even other students. And so we bought into it. I bought into it, taking A.P. Biology, Chemistry, Spanish, U.S. History, and Calculus throughout my junior and senior years. I scored well on the exams, and earned enough college credit so that when I entered the University of Illinois in the fall of 1999, I was technically a second-semester sophomore – not a freshman – in terms of credits. I was able to bypass introductory courses and take more advanced (and smaller) classes, which was a major advantage at a huge university such as UIUC.

Pretty sweet. Or so I thought.

It turns out, however, that medical schools do not look favorably on A.P. credits. They want students to have taken the courses at a university. Which means that I will have to retake Calculus. Which, in my mind, makes no sense. It’s not that I’m afraid of Calculus – I got an A in the course the first time, and scored a 5 on the A.P. exam, so I am clearly capable of mastering the material. No, what doesn’t make sense is that I have already mastered the material and have to prove it all over again. And spend several thousand dollars (and dozens of hours of my time, and god only knows how much pencil lead and calculator juice) doing so, just to have that line item on my transcript.

So my A.P. credit is worthless. I busted ass – and when I say I busted ass, I mean BUSTED ASS, because Calculus isn’t easy – for jack. No, I shouldn’t say that; not for jack, because I did learn the material, and it’ll be easier the second time around.

But then is the whole A.P. thing a sham? A waste of time, a way for the College Board (the institution that sponsors the A.P. exams) to make money, a way for Cliff’s Notes to make money on review books, a way for schools to tout their students’ success, a way for students to boost their GPAs (many schools offer an extra GPA point for honors and A.P. classes) and to claim superiority over others who take fewer A.P. courses or who do not score as well on the exams?

Perhaps A.P. courses – and credit – are worthwhile for students who enter less competitive fields, or who do not intend on completing graduate level work. But apparently they are worthless for those of us who intend on entering medical school.

Which is frustrating, since taking A.P. courses was, in high school, the indicator of success and high achievement. And that’s what – I thought – medical schools wanted.

In an ideal world, medical schools would accept A.P. credits. If they have issues with the A.P. curriculum, they should take that up with the College Board. But this is not an ideal world, obviously. So it would be helpful for high school guidance counselors to let students know that taking A.P. credits doesn’t necessarily guarantee that you will get to skip out of that class in the future.

If I had to do it all over again, I would still take A.P. Calculus in high school. I learned a new way of approaching math, and when I take this course again this fall, I will be ahead of the game. But I’ve also learned that to get into medical school, you have to play their game. And it’s a frustrating one.