Roller Coaster Friday

Sometimes, once what feels like an awful day is over and you've recovered, it's hard to see why it was so bad. Especially if one of the root causes of your crappy day was that you were overtired. But I think last Friday was legitimately bad, and was only exacerbated by my fatigue.

During PBL (problem-based learning; it is a case-based learning system), we found out that one of our classmates is leaving for the next unit, and may actually have to leave our class and rejoin the class below us. She has been struggling with depression and chronic migraines for a long time now, so although it's not surprising to any of us that she needs time off, it still sucks that she is suffering to the extent that she can't function as a medical student. I, after having told myself I would never cry during class, found myself in tears at the thought of losing one of my best friends at school. Of course, it sort of didn't occur to me that since we don't often work in the same group and she was still going to be in clinical skills and other classes with me, and because she lives three blocks away, she would still be relatively available. Just in case you're wondering, the incidence of severe, clinical depression among medical students is, unsurprisingly, very high. Check out this article by Sydney Spiesel at Slate: http://www.slate.com/id/2201190/

It didn't help that I wrote the crappiest paper I've written to date for medical school -- I essentially didn't understand the material, allowed myself to get intimidated by it, wrote four or five false starts, stayed up way too late writing it, and then produced something that required a lot of explanation from me in order to be informative. Then our group found out that our friend was leaving, so I found myself without enough time to explain my crappy paper. Thus, I felt like I had failed my group. I told them that I broke the rule where I don't cry and the rule where I always write a good paper (of course, I meant always try to write a good paper). One of my classmates said perhaps the best thing anyone could have, "Those are stupid rules." Not usually, perhaps, but it was nice to hear it. I HATE producing lousy work, it's my most unfavorite thing.

The day, like any roller coaster, did have its upsides. We had a lecture from an allergy & immunology specialist, so I asked her about the strange phenomenon I have when I run. I get really, really itchy on my thighs especially, but arms, hips, and butt are all prone to it, too. There isn't a rash, just my skin turns red and gets so itchy that I feel like if I don't stop and scratch I'll die, but if I scratch, it gets itchier until I feel like I'm going to pass out. This all happens right before I start sweating and stops once I'm sweaty. It only happens outdoors when I run, not during a game or in the gym. She told me two things: One, that 'itch sensation' is not the same spinal tract as pain sensation, so it is its own thing; and two, that what is happening is that when I run, I'm getting warm but not sweating, and that the heat stimulates the itch receptors and makes me itch. Sweat causes evaporation and cools the skin, which calms the receptors.

I've only ever heard of one other explanation for this: that when you run, and you're out of shape, your capillaries expand suddenly, which causes you to itch. If you're in shape, they vasodilate much more easily, and that doesn't make you itch. The two explanations are not mutually exclusive, but they both suggest something interesting: that you should warm up at the gym until you're sweating, then go outside, and that should help.

I have heard of other people with this condition, so there you are. The first explanation is from a specialist, the second is from a general practitioner. Both mean that you can run through it safely without having an allergic reaction (which is what I was afraid of), but that you can't really 'cure' it unless being in shape helps.

The other good part of Friday was that I met my geriatric preceptor. She's incredible. She's this very resilient-appearing, calm, peaceful rehabilitation neurologist. She has volunteered with Medecins Sans Frontiers in Asia, and has been to the elephant sanctuary in Thailand that I really want to visit (too bad I'm not living in Singapore anymore). She has also been to India, and I suspect she's buddhist. We set up dates to meet, and as I left via the elevator, she walked me out and namaste'd me. It wasn't offensive; it was charming. I'm in love with that lady and I totally want to be her when I grow up.