Tag Archives: medical school

Leonard Cohen Birthday Gift Registry #3. Medical Degree

giftreg

The Background

The third selection from the Leonard Cohen 75th Birthday Registry1 not only extends Mr. Cohen’s career options but could literally be a lifesaver for anyone who takes him up on his offer in “I’m Your Man:”

And if you want a doctor
I’ll examine every inch of you

Leonard Cohen With Boxing Gloves and Stethoscope (Colmar)

Leonard Cohen With Boxing Gloves and Stethoscope (Colmar)

In “I’m Your Man,” of course, Mr. Cohen lists several personas other than physician he is willing to assume  (e.g., boxer, lover, driver, mask-wearer).  While anyone celebrating his 75th birthday might be well advised to consider the wisdom of participating in boxing, none of  those roles – except that of  physician – would likely put anyone at risk other than  Cohen himself.

Although  the potential for physical harm from the proposed examination, however thorough it might be,2  seems slight, performing an appendectomy, for example, might lead to problems. And, there is the matter of  legal liability involved for holding oneself out to be a licensed medical doctor.

Given those potential risks and Mr. Cohen’s imminent need for a new avocation with the end of the World Tour this fall, what better birthday present could one give than a Harvard medical degree? If he gets started right away, he could be celebrating his 80th birthday as Leonard Cohen, MD.

cohenmd

Medical Education Cost

From Harvard Medical School Costs

Harvard Medical School tuition rates are reset annually and cover courses taken from August 1 through June 30 each year up to the final year of enrollment ending with graduation. Tuition is billed by semester. Two forms of term bill payment are available: payment in full by semester or monthly payments (payments for the year are spread over eight months). The monthly payment plan carries a service charge of $35 per semester.

An estimate of yearly expenses shows that the average cost for an unmarried first-year student will be approximately $66,600 for the 10.5-month academic year 2009-2010. This estimate includes tuition, health service fee and insurance premium, room and board, books, travel, transportation to clinical sites, laundry, and incidentals. Students whose homes are outside the northeast region of the United States may experience travel costs beyond the scope of this estimate.

Students who opt for the 5-year program or whose time for meeting degree requirements at Harvard Medical School exceeds eight semesters and who have paid eight semesters of full tuition will be assessed a reduced tuition charge for each semester of enrollment beyond the eighth. This reduced tuition is expected to be $2,450 per semester in 2009-2010.

Tuition and Fees for a First Year Student are as follows:

2009-2010
Tuition $42,500
Univ. Health
Services Fee
$1,126
Blue Cross /
Blue Shield
$1,714
Disability Insurance $63
Matriculation Fee $35
Educational Materials Fee $395
Vanderbilt Hall
(avg. rent)
$7,680
Other living expenses (including travel, living expenses and transportation) $10,210
  1. To aid fans in selecting gifts to celebrate Leonard Cohen’s 75th birthday September 21, 2009, Heck Of A Guy has opened the Leonard Cohen Birthday Gift Service and Registry, offering advice and assistance in choosing that just right birthday present, whatever ones budget or Cohenist preferences (e.g., early Cohen, post-1979 Cohen, “everything except Death Of A Ladies’ Man,” etc.). For the complete story, see The Leonard Cohen 75th Birthday Gift Registry []
  2. The gambit of  proffering an extremely meticulous medical examination on a member of the opposite sex is an idea that has occurred to others (i.e., every male medical student DrHGuy has ever known) as well as Leonard Cohen. []

Lord of Leisure Vs Semliki Forest Virus

Contest Continues For Years With Unknown Rules and Indeterminate Scoring – Yet Isn’t Cricket

This is your mouse's brain on Semliki Forest Virus

To quickly and efficaciously invoke the mood appropriate to this tale, the reader is advised to imagine an introduction offered by either Rod Serling uttering half-ominously, half whimsically, one of his cryptic preambles to a Twilight Zone episode, “Submitted for your approval, … ,” or Alfred Hitchcock, walking on screen toward the silhouette of himself to Charles Gounod’s Funeral March of a Marionette, then turning toward to camera to sonorously announce with exaggerated precision, “Good Evening. I’m Alfred Hitchcock and tonight … .”

Because this is a story of the Scientist Becomes Science Experiment genre.

The Plot

In 1972, Lord of Leisure,1 Duke of Derm, Princess of Peds, DrHGuy, and 96 or so other overachievers were in the first semester of their second year of medical school in the heartland of America. Part of the second year curriculum, at least in those days, was microbiology, and part of microbiology was the “Mouse Encephalitis Lab.”

While the ultimate didactic purpose of the lab has long been forgotten by Lord of Leisure and DrHGuy, the preparation stage is permanently lodged in a prominent portion of the cortex.

The essential step in the lab exercise was inducing encephalitis in a number of rodents by the simple expedient of injecting their brains with Semliki Forest virus.2

Thus it was that Lord of Leisure, equipped with a virus-loaded syringe in one hand and a mouse in the other, brought them into approximation to effect entry of the virus via the syringe into the mouse’s brain.

That’s when things went awry.

Inserting the needle of the syringe into the mouse as directed, Lord of Leisure applied pressure to the plunger but to no avail. Perhaps the needle was clogged or the lumen was wedged against the mouse’s skull or jammed into a cul-de-sac of tissue. Regardless, the virus remained in the syringe rather than in the mouse, endangering the lab exercise (from the medical students’ perspective albeit not necessarily the mouse’s).

Conscious of his responsibility, Lord of Leisure readjusted his grip on the syringe, positioned his thumb squarely on the plunger, and in a particularly masculine maneuver, applied significantly more pressure,3 forcing the syringe’s contents from the cylinder into the needle and finally into the mouse – but only briefly.

Upon exiting the syringe, the Semliki Forest virus solution ricocheted off whatever part of the mouse’s anatomy was blocking the needle’s exist directly backwards into the eyes of Lord of Leisure.

Panic ensured – especially and understandably on the part of Lord of Leisure.

But wait – the trauma has yet to peak.

The Dark Ages

After a few hours of flushing his eyes, the Lord of Leisure took steps to assess his situation as a potential Semliki Forest virus host. In those pre-Google days his options for garnering somewhat esoteric information were limited.

First, he tracked down the wooden clog-shod, 6′ 6″ effete microbiology instructor who devised the lab and provided the virus, although he was nowhere in the vicinity when the lab was in process. It was, in fact, a few days later that Lord of Leisure was able to query him about the risks he faced and likely outcome of the incident.

The microbiologist was not worried.

Well, more accurately, the microbiologist wasn’t concerned about Lord of Leisure’s angst or any of the problems (e.g., a prolonged, horribly painful death) he might face.

He did admit that he didn’t know if Lord of Leisure were in any danger but, on the other hand, apparently felt capable of tolerating that ambiguity.

Lord of Leisure describes his next approach:

My own research of what little was then known about the Semliki Forest virus revealed that human brain tissue could be afflicted with the virus, which was best known for its incubation period that could be as long as 20-25 years.

I did not find this comforting.

Model of Semliki Forest Virus

See? This is the part of the story where the dynamic tension is greatest, the potential for catastrophe weighs heaviest on our protagonist, and the pathos reaches seemingly unendurable proportions, yet it is not, if the reactions of several of our fellow students are any guide, without a certain macabre hilarity.

One friend, in fact, continued to mention the viral incubation time in his Christmas cards to Lord of Leisure, in a sort of annual countdown, for those 25 years.

As it came to pass, the incubation period elapsed without Lord of Leisure running in circles, exhibiting restlessness, or manifesting any of the symptoms those encephalitic mice demonstrated. He is now out of the woods – or, as he prefers, “out of the Semliki Forest.”

Here’s the kicker. When I asked Lord of Leisure for details in preparation for writing this post, he Googled “Semliki Forest virus” where he found 310,000 hits, including the information that the danger to humans is minimal, as indicated by this excerpt from Wikipedia:

The Semliki Forest virus (or Semiliki Forest virus) was first isolated from mosquitoes in the Semliki Forest, Uganda by the Uganda Virus Research Institute in 1942. It is known to cause disease in both animals and man. It is an Alphavirus found in central, eastern, and southern Africa. The Semliki Forest virus is a positive-stranded RNA virus with icosahedral capsid which is enveloped by a lipid bilayer, derived from the host cell. … Semliki Forest virus is spread mainly by mosquito bites. It is not able to infect mammals through inhalation or gastrointestinal exposure although rodents in the laboratory can be infected by intranasal instillation. The virus is able to cause a lethal encephalitis in rodents, but only one lethal human infection has been reported. Even in this one case, the patient was immunodeficient and had been exposed to large amounts of virus in the laboratory. Semliki Forest virus has been used extensively in biological research as a model of the viral life cycle and of viral neuropathy. Due to its broad host range and efficient replication, it has also been developed as a vector for genes encoding vaccines and anti-cancer agents, and as a tool in gene therapy. [emphasis mine]

So, boys and girls, although Lord of Leisure and DrHGuy recall precious little about mouse encephalitis, we do have a grasp on the real lesson to be learned from this Parable of the Mouse Encephalitis Lab.

Google is your friend
(Whether your microbiology instructor is or not)

  1. Lord of Leisure was previously known in these posts as Mr. Science. Both Lord of Leisure and Mr Science spend most of their time disguised as Neil Ellis, mild-mannered, retired teacher at a great suburban school system, who can identify a bird by its call, complete the New York Times Friday Crossword in ink, and snap a heck of a photo. In addition to his sporadically ongoing Lord of Leisure Photo Gallery series, featuring shots of outdoor scenes such as Greer Springs In The Missouri Ozarks, Lord of Leisure has made numerous contributions to the Heck of a Guy blog, The Ziploc Omelette Buffet recipe, birding observations, participation in the blogumentary of Chocolodka Production, a key role in The Great Ozark Folk Festival Flood of 1973, and Hilton Head Vacation Expert in Residence on Crossword Puzzles, Sports, Photography, and the Great Outdoors as well as story-teller par excellence. He also serves as spouse of Hippie With Tiara, no stranger herself to these posts, and father and father-in-law, respectively, of the recently wed Son of Science and Eager Teacher, whose recent adventures in adulthood may well find their way to future Heck of a Guy entries. Lord of Leisure also has a daughter and son-in-law, both of who have inexplicably escaped the Heck of a Guy spotlight – for the nonce. []
  2. It should be noted that medical school was awash in fun projects of this sort, each of which prompted in DrHGuy a nostalgic longing for his halcyon undergraduate days as a English major, when an onerous assignment consisted of reading The Red Badge of Courage or The Pearl (both the 14th century, Middle English alliterative poem and the Steinbeck novel – each is gruesome in its own way). Not once in a lit course – including Contemporary American Poetry – was DrHGuy expected to inject a tissue-destroying virus into the brain of a mouse. []
  3. OK, show of hands – who thought DrHGuy was going to use, instead of “applied significantly more pressure,” the phrase, “plunged ahead,” as a play on “plunger?” []

The Medical Specialties Witticism

DrHGuy first heard this while in medical school. It is also the only joke DrHGuy recalls from medical school that doesn’t feature a cadaver.

The Medical Specialties

Internist: A doctor who knows everything but does nothing.

Surgeon: A doctor who knows nothing but does everything.

Psychiatrist: A doctor who knows nothing and does nothing.

Pathologist: A doctor who knows everything and does everything — but too late.

How MrGuy Became DrGuy

An astute reader has noted that yesterday’s account of my soi-disant “straight-forwardly conventional” plod through life included the less than straight-forward jump from earning a BA in English in May to entering medical school in September, and has asked for an explanation.

Okey Dokey

Why

First of all, being a doc, at least in the 70′s, wasn’t a bad gig: physicians performed important work, were paid well, and were generally respected. Health insurance companies issued checks instead of denials, and, sometimes, a “MD” after ones name could garner an otherwise unavailable restaurant reservation. To a kid from the Ozarks, this was, if not the good life, a reasonable substitute until the real thing came along.

In addition to these standard reasons to choose medicine as a vocation, there were a couple of other compelling factors.

1. My draft lottery number was #19, a ranking that offered me the opportunity to supplement my knowledge of iambic pentameter, my expertise in reciting Chaucer in the original Middle English, and my insight into the overvaluation of Baudelaire’s influence on T.S. Eliot with the ability to field-strip an M-16 and wade through chest-high swamp water in Viet Nam. There was, I admit, an allure to the notion of learning the doctoring trade while indefinitely deferring the chance to be all that I could be. (I was never clear on the benefits of being all that I could be if that included being a target for enemy snipers or a preferential host for intestinal parasites indigenous to southeast Asia.)

2. When my father asked me what I intended to do with my life, I replied with my whim du jour, “I’ll go to graduate school and get a Ph.D. in English Literature.” My father’s next question, spoken without a trace of irony, was, “OK, how much does that pay?” In the ensuing conversation, he offered to pay for my future schooling if it eventuated in a medical or law degree. (My dad, by the way, was a unsuccessful farmer who built an impressively profitable business buying used cars in Michigan and wholesaling them to dealers in Missouri and Oklahoma; I suspect he knew I didn’t have what it took to follow in his footsteps – although it remains my contention that  I could have handled the failed farmer bit.) As it turns out, there was a substantial gap between his definition “pay for my future schooling” and my interpretation of that concept, but by the time that difference was evident, I was ensconced in my first year of medical school.

How

So, the reasons behind my choice of medical school were perhaps complex but not atypical. Why a medical school accepted me is quirkier.

Happily, one of that era’s political fads coincided with my application to medical school. Several predominantly rural states were then harrumphing and denouncing their medical schools that turned out doctors for urban centers and did little for the underserved countryside. Consequently, state-supported medical schools were threatened with reductions in funding unless they accepted more students from rural areas of the state because – and here is the bizarre part, so pay attention – those individuals would become MD’s who would return to practice in the areas where they were raised. It is but to snicker. Why, one might hypothetically query those legislators lounging around Jefferson City (Missouri’s capital), do you think folks who survived growing up on southwestern Missouri farms most suitable for growing bumper crops of rocks and then managed to get through local facsimiles of colleges want to go to medical school in the first place? Well, the answer to me was obvious: (1) To be a doctor for all the afore-listed reasons (2) To exchange the rustic rigors of country living for the bright lights and dark temptations of the city. As Homer Simpson (who, coincidentally enough, resembled the legislator from our district) would say, “D’oh.” In any case, I suspect that sending my application from an address that included “Rural Route 5″ enhanced my prospects at the University of Missouri.

A second serendipitous political trend in the early 1970′s was the notion that every class of medical students would needed a token student who was not a science jock, a position for which I was eminently qualified. On the day I received my letter of acceptance to medical school, I had a total of five hours of traditional pre-med science courses; at that time I also had six hours of Bible courses (residual from my aborted shot at the ministry).

The final stroke of my master plan required the shrewdness to be  randomly matched for my interview with a Dean who was an expatiated New Yorker with a penchant for political involvement. When he unexpectedly asked why I had not elaborated on one of my few extracurricular activities, serving as Chief Justice on my college’s Student Court, I was too taken aback to fabricate a believable, self-aggrandizing explanation and replied, truthfully, that is was political patronage. To support a friend of mine who was a candidate for student body president, I published a couple of editions of an underground, muckraking newspaper. When he won, he offered me my choice of appointments and Chief Justice had the most grandiloquent title with the least work. (I did manage to refrain from blurting out that last part.) That, apparently, was the right answer or, perhaps, the secret word of the day.