A top concern of the premedical student is contemplating his tolerance of the sometimes gruesome process of dissection. Early in the semester we, too, split off into groups of four for each cadaver and nervously peeked within the black body bags, the pale lifeless body covered by a damp cloth. But it's true, one becomes quickly inured to the frankness with which we (respectfully) explore the body.

Dissection is a long process, taking roughly 3-4 hours three days a week over a dozen weeks, resulting in roughly four hundred hours total. Each day's dissection covers a specific part of the body - we might study the rib cage and the lungs one day and the heart another. Slowly we move throughout the body, placing organs in plastic bags and exposing muscles until what remains is a far cry from the intact human at the beginning of the term.

Rembrandt's "The Dissection." Sadly wearing frilled collars was removed from our medical curriculum last year.

Fat is an everpresent barrier, and indeed much of the day is spent digging through preserved globules of fat for items of interests (one of HST's groups had the fortune of dissecting a cadaver with virtually no visible body fat, which incidentally allows them to complete dissections more quickly). I therefore often find myself questioning the utility of dissection as we spend 20 minutes trying to distinguish the glossopharyngeal nerve from the vagus nerve in the neck and ultimately discovering that we nicked the glossopharyngeal earlier. In a three hour dissection, we could have potentially memorized far more than we discovered in the body that day.

Indeed, some medical schools are dispensing with cadaver dissection altogether and moving to an electronic modeling system. Arguably having a three-dimensional representation vividly memorized in one's head is as practically useful as seeing it on an actual body.

Yet there are some moments of profound discovery that redeem every last hour on the dissection. One came early when I cut the connections of the right lung to the body, lifted it out of the body, and held it in my hand, spongy and surprisingly heavy. A perforation of the lining of the lung - from a stab wound, say - would immediately collapse it, preventing air from entering. Bacteria can infiltrate them quite easily and build up fluid in the lungs. Yet it otherwise functions perfectly every normal day, supplying crucial oxygen throughout our bodies, without which we would die within minutes.

Another moment came from dissection of the arm and hand. Consider for a second all the possible motions of each finger. With your fingers outstretched and palm up, you can move your fingers left, right, up, down; curl and uncurl them; and all combinations of these. Think about what a complex task typing on a keyboard is, moving multiple fingers to precise locations in sync over and over again.

Each individual motion of the finger is controlled by a single muscle, such that operation of the hand requires over a dozen muscles. Yet the anatomy of the hand makes perfect sense. By pulling on the specific muscle, I could make each finger move according to the muscle's function. This reminded me of a very complex marionette, with an overseer rapidly pulling strings to make me type an email.

Muscles in the arm and hand control movements of the fingers. This is just the top most layer of the back of your hand.

The overseer is the brain, and when we recently cut out the brain from the cadaver's skull and held it in our hands, I realized that this pale, spongy mass was responsible for our recognition of our existence and all subsequent behaviors. Somewhere in this dense mess, neurons were connected with each other such that we could actually reason theoretically and make extraordinarily complex decisions. Yet you break open the skull or put a bullet through it, and that can all disappear. The brain begins to die irrecoverably from lack of oxygen within 5 minutes.

Dissection and anatomy have taught me a vast body of material that may be practical in the future. But more powerfully, it has also made me appreciate simultaneously the human body's complexity and fragility. I think it is a wonder that such a complex being resulted from gradual improvements from microbes, even if it took a billion years. That a spinal cord the thickness of a quarter can relay messages from the spongy mass of the brain and control millions of processes in the body is still astounding to me.

Knowledge of human anatomy is arguably more important in some specialties - surgery, radiology, pathology - than in others - anesthesiology, medical oncology. But a respect for the body is indispensable in all.

The problem is not that we lack interest in what is being taught, that the lecturer is monotonous, or that our water supplies have been poisoned with opiates. Instead, there simply isn't enough time in the day. When we finish the day at 6PM, having been in class since 8:30AM, the last thing we want to do is hit the books. So with dinner, a TV show, and some dilly-dallying, suddenly it's 8PM. There's the day's material to review, the next day's dissection to prepare for, problem sets to complete, cases to research. Now it's 1AM and time to sleep, but I rarely feel like I have had enough time to enjoy for myself.

A few older medical students warned me that there is simply too much medical knowledge coming in the first year to be able to learn everything. Instead, I would have to be selective and choose what I was most interested in. I was incredulous, as this had never happened before, even with some demanding schedules at Harvard as an undergrad. But it is slowly becoming more apparent.

I should stop whining about this since this is just the very beginning, and clinical rotations and residency should be far worse. But what a toll medical school can have on our daily lives, and how much stronger we will be (maybe in worse health) after we leave.

It's been a painful and long illness, and I have two salient thoughts on it:

• People actually want to avoid you. This is somewhat obvious and logical, but it actually made me feel alienated. I would quarantine myself in a corner of the classroom, but other times students would purposefully avoid being around me. This is nothing compared to the stigma HIV/AIDS patients faced in the 1980s/90s, and I am so happy that education has changed much of that, at least in some areas. Experiencing what a patient endures can really make you a more understanding doctor.
• An itchy throat is annoying, the tiny little scratch in the back of the throat that forces you to cough but won't disappear even when you do. I was often in situations when I really did not want to cough repeatedly - in lecture or in public - and could go red in the face just trying to suppress the cough. Fun fact: this itchy sensation is caused by irritation of the mucosal membrane, often when there is insufficient mucus.

I'm glad to be somewhat healthy again, and I hope it doesn't repeat later in the winter.

There's a slight possibility that it's the dreaded H1N1. In April, a few students at Harvard Dental School were verified to have H1N1. The (unverified) story goes that a student's boyfriend had visited Mexico, returned, and the two of them visited parties without showing symptoms. In response the school was shut down for several days.

The H1N1 flu is common enough now that cases do not need to be sent to the Centers for Disease Control (CDC) for verification, but it is still a looming threat in the coming flu season.

In any case, I'm going to take it easy for a while until I recover more.

On Saturday, I woke up with a sore throat. I thought nothing of it and went to a review session (class on Saturday!) but became increasingly feverish over the day. By night, I had a full-blown fever with chills and a raging sore throat. I slept throughout the night and had some delirious dreams as typical of a fever, and I woke repeatedly in the night.

Today I rose perfectly fine, a mild sore throat but no fever. I was surprised by this as I had never developed and resolved fever so rapidly. Like a proper medical student, I began reaching from my (limited) knowledge. We had learned in immunology that when the immune system fights off an infection, the next time it sees that disease the response is much swifter and fiercer. Maybe that was what happened? Did the basketball play have anything to do with it, perhaps increasing respiratory distress?

Usually I tell people (my parents especially) that I haven't been sick in years and that I'll be fine in flu season. Can't be quite so smug now.

The primary goal of the program is to train physician-scientists. Ideally, the graduates will both manage their own laboratories while seeing patients, although some graduates tend to go entirely into medical practice or research. A large component of what we learn is therefore cutting-edge research in the field. Each week in all our classes we will probably have at least four scientists in the field explaining their work and the state of the field.

This means that what we learn is not directly relevant for medical practice or for our medical licensing exam, but the point is instead to train a system of thinking about medical science.

Within the rest of the medical school, the HST student is stereotyped as being nerdy, less attractive, and bookish. But this is OK, as we have fun stereotypes for the other programs as well.

I wanted to take this chance to reflect on case-based learning, the mainstay of New Pathway and most other medical schools in the country. A patient's clinical case is presented, usually with uncertainty about the underlying disease. Uncertain parts of the case - test results, symptoms, X-ray readings, family history - are split among students to research, and upon reconvening each student shares his research with everyone else. Gradually the case is clarified with help from a supervising group leader, usually a doctor.

For me, this system was inefficient for learning. An entire two-hour session could be distilled into a single sheet of paper that could be read in fifteen minutes. Our group would also often branch into unrelated tangents on minor details, bringing up interesting facts that were irrelevant to the case.

I am not suggesting that the problem-based learning model is without merit. The benefits of this system are clear - it resembles real clinical practice in that the patient's condition is often unknown and requires gradual steps to figure out. Furthermore,it encourages collaboration between students, building the type of collaborative spirit central to medical teams in hospitals.

Ultimately the question is whether medical school is about learning the facts or learning the skills of becoming a doctor. Of course, it should be about both. But in these cases, the only skills we practiced were researching a narrow part of the overall case and presenting information to other students, both of which you either already have or can develop quickly. Once these skills are developed, future cases become inefficient in the learning you do per amount of time.

I would rather first build a solid foundation of knowledge through efficient learning, then progress to case work when I am not as clueless.

Medical students - how do you feel about case based learning?

They're walking along chatting about their work when all of a sudden a man drifts by in the middle of the river, screaming for help. The doctors immediately spring into action, one doctor standing by the bank for support while the other dives into the river. He pulls the man, swims to shore, and they both climb out soaking wet.

The two doctors continue their stroll when a woman drifts by in the river again, just screaming for dear life. The doctors rush again, and they save the woman from drowning.

They walk further down the river until another man comes down the streaming river, at risk of drowning. One doctor immediately dives in, but this time the other doctor runs away up the river, inexplicably. The swimming doctor manages to save the man, and he waits by the side of the river for his friend to return.

When he does, the wet doctor asks, "Why in the world did you run away when I was trying to save him?"

The other doctor says, "I went upstream trying to see why so many people were falling in the river!"

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This is a cute story, but it also illustrates the multiple roles physicians can have in society. They can serve on the frontlines treating patients with what we currently know, or they can research the unknown about why diseases happen. Both are absolutely essential roles in  medicine.

In this inaugural post, I want to describe an experience that motivated me to create this blog to chronicle my medical education.

In our summer MDPhD course, William Hahn, a cancer biologist and oncologist at Dana Farber, discussed a paper for the drug cetuximab,  an antibody therapy for colon cancer. Cetuximab was shown to be more likely to be effective in patients without a certain mutation in their cancer cells. This is an expensive therapy, costing about $30,000 for an 8-week course. Furthermore, they show only a modest increase in stopping the disease, roughly two months, during which quality of life suffers from side effects and intravenous administration.

It therefore seems wise to screen patients for the lack of this mutation to determine if the treatment is likely to be successful, and indeed this is standard practice. It's not so simple, though. A low percentage of patients with the mutation also respond to treatment. In this case, it was one patient (1.2% of those without the mutation).

A patient nearing the end of life and the supporting family will often do anything to extend that lifetime. I certainly would try for myself and anyone I cared about. Even if there was just a 1.2% or a .01% chance that the treatment might give a few months of extra life, I would take that chance, even though the science overwhelmingly discourages it. After all, that patient could just be that lucky one out of a thousand.

And so the dilemma surfaces. As a doctor, I want to do everything I can to help the patient, even in the most unlikely of scenarios. I would expect the same of my own doctor. Yet if all doctors felt this way and supported treatments that were very unlikely to work, healthcare costs rise uncontrollably, and the medical institution as a whole suffers.

So with whom do our responsibilities lie?

I don't know the answers to these questions, but I aim to figure them out for myself over many years in the future.

My mission in this blog is to discuss questions like these. I want to describe my medical education, to be frank about my fears and hesitations, and to share the lighter parts of becoming a doctor. I hope that it reveals insight into how your doctors become who they are and what issues we constantly grapple with while we practice.

It's going to be an exciting ride.