The takeaway from my first full day of exam prep was the jaw-dropping wonder of the beginning of human development — and how as doctors, we may actually be able to help mothers someday through successful pregancies.
My original plan for today, day 2 of 14 towards our embryology, histology, and microanatomy exam, was to study embryology through the sixth week of development. I did not quite make it that far; I made it through the third week. However, I am not super-worried about this, because getting through weeks four through six should add one extra day to my schedule, which still has one day of buffer. Hopefully, a topic or two in the remaining days will take a little less time. Studying is like that: you make a plan, but you adjust as you go along, and hope that things will turn out all right in the end.
Here are some pictures to give you an idea of where I am physically located. I have a study room in my apartment in Milan. The room is very quiet, and smells nice because I bought lavender air freshener at Lidl down the street. There are basically two study spaces in the room. My desk…
…and my couch, with cozy blankets for the chilly Milan winter…
…and which has a table next to it, which basically always haş textbooks, computer, and a cup of warm tea on it.
Although somehow studying seems more official if you are doing it at a desk, I spend nearly all my study time these days on the couch. I only use the desk when I have to write a lot by hand (say, do physics problems), or am reading a textbook from a computer screen, in which case I prefer the big monitor.
Today I dove into the first chapters of The Developing Human: Clinically-Oriented Embryology, by Moore, Persaud, and Torchia. This is a really great textbook. Embyrology is notoriously difficult to explain in words; it is learned through diagrams and videos. This textbook, however, if you give it time — and you have to go slowly, sentence-by-sentence, image-by-image — actually does promise a clear understanding of the intracacies of how embryos and fetuses change from day-to-day inside the womb. This is not simple at all to grasp, because a) it is very difficult to photograph embryos, especially in the first weeks of development, b) embryos do not look much like humans who have already been born, so there are few points of reference to the real world, and c) the changes are three-dimensional, so it is tricky to describe them on the two-dimensional surface of a piece of paper. This book does it as well as any, and furthermore, it is the first textbook we have used which asks you to try to solve real clinical problems.
Once you start to get a sense of embryology, you realize you are learning something quite profound. In its first weeks, the human embryo is nothing more than a bunch of cells making up simple shapes. First it is a ball — a morula — then it is a sphere (filled in a bit) — a blastula — and later it is flat and round — an embryonic disk. That disk develops a little line across its surface, the primitive streak, which for a while directs the cells of the growing embryo where to go and what kind of tissue to become. At this point, the developing human is one millimeter long. On the right is the morula in Gray’s Anatomy. There is actually a to scale image of an embryonic disk in the book. It is so tiny, I almost missed it. For a few seconds I was transfixed on this blotch of ink, representing this miniature bud of a future person, thinking, I was that small one day!
So much of the joy of studying medicine is the insight you gain into yourself.
The other aspect of my study today that was particularly satisfying were the clinical case studies. Each chapter has several of them. Here’s one, for example:
I can very well imagine someday, sitting in my office… and in comes a potential mother concerned about how drinking wine might have affected her pregnancy. My studies require me to understand the science behind this question — what organ systems are exactly developing in the embryo at this time, how alcohol might affect the chemical factors that drive that development — but I am also invited to think about how I would actually handle the human situation. What tone of voice, what diplomatic language, what level of detail would I go into, in order to calm this person’s fears and help her make the right decisions? How will I take what is in these pages and on our lecture slides, and apply it in the interests of human compassion?
Erik Campano is a consultant to the English medical school of the University of Turin and doing a Master's degree studying artificial intelligence applications in global health at the University of Umeå, Sweden. He completed his Bachelor’s of science in Symbolic Systems at Stanford University, and then he worked for about eight years as a radio news anchor, before moving to biomedical scientific study and research at the University of Paris and Columbia University. His goal is to develop AI technologies for international emergency humanitarian aid organizations like Doctors without Borders, and to combine medicine and journalism. Erik grew up in Connecticut, and is a citizen of the United States and Germany.
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