Well hello, friends! It sure has been a while. Please, come in! Have a seat; make yourselves at home. Pull up a chair, kick up your feet, and I'll tell you a tale of my life.
Now, where did we last leave off? Ah, that's right. We last left our hero (that's me!) several weeks back in the midst of a class called Cell Structure and Function. Well, a lot has happened since then, and boy are you in for a treat. But before we get to the really good stuff, let me start with a quick summary of the last few weeks. Where shall I begin? Well, how about with number one...
1. I am currently about halfway through with the third course of my first-year curriculum, entitled Systems, Processes and Homeostasis (SPH). Since that title isn't particularly informative, you can essentially just think of it as Physiology and Pharmacology. In terms of physiology, we focus on various organ systems; we started with the peripheral nervous system, are just now finishing up with the heart (which is AWESOME, by the way), and then we move on the the kidneys, etc. As for the pharmacology, we are responsible for learning 150 drugs this term (including drug class, subtype, effects, mechanism of action, etc.), which is a fairly daunting task in its own right.
2. I had my second OSCE a few days back. If you recall from a previous post, this is the practical examination that we have at the end of every term of PCM to test our physical exam skills. Last time it went ok, though not as well as I had hoped. This time went much better; even though it still felt like an act, I was much less nervous, and ultimately had a lot of fun with the patients.
3. I've also been working on getting my summer plans in order. I've decided that I want to work in clinics abroad. Now I'm just working on deciding on a destination. I think I've narrowed it down to either Ecuador or Tanzania. Right now I'm leaning toward the former. Either way, I know it will be an incredible experience, and I can't wait to get all my plans in order. More to come.
4. Next week I will be starting with my third (and final) preceptorship for the year. This time around I've been assigned to work with an OHSU trauma surgeon, so that should be super exciting. You can expect some updates on that in the near future as well.
Ok. I think that should be sufficient. Now on to current events. Throughout SPH, we have the opportunity to participate in various optional labs outside of class time. None of my previous classes have had this, and so far I think it is a really neat addition. Not only are the labs fun, but the help to reinforce the concepts that we are learning in lecture. So far I've completed two of the labs (both for the cardiovascular section of the course). Next up will be a renal lab, and so on.
So the first one I went to was the cardiovascular simulator. The purpose of this lab was to watch, in real time, the effects of extensive, rapid blood loss on various vital signs and cardiovascular measurements (e.g. heart rate, blood pressure, respiratory rate, central venous pressure, etc.) For the simulation, they basically had an electronic mannequin, into which the could inject fluids and remove blood, hooked up to clinical monitoring equipment. We used this setup to simulate a patient losing two liters of blood over the course of ten minutes (that's a lot). First we predicted the effects that we expected, then we watched them first hand. Finally, we had the opportunity to decide which drug to give to the patient to try to get his vitals back into a more acceptable range. Overall, it was a pretty cool experience, and was fairly educational as well. As it turns out, it apparently costs the school hundreds of thousands of dollars to run the simulation. Dang.
Ok. And now we get to the best part, the veritable climax of this chapter, a thrilling end to the young hero's recent adventures. Today I had my second lab of the course, the CV lab, or, as many refer to it, simply the pig lab. For this lab, we had the (unbelievably unique) opportunity to perform surgical procedures on LIVE animals, an opportunity that is hard to come by--even by medical school standards. The procedures involved were basically those you would see performed during an angiogram, minus the imaging portion. These techniques are used to measure various pressures inside the different chambers of the heart, as well as to take small samples of blood from these areas to make various useful measurements, such as hematocrit. The purpose was, as in the simulator lab, to look at how these values change under various conditions (more on that in a moment). So here's how it went down...
We worked in groups of six, our patient: a several month old, 62.5lb male pig given muscle relaxants, analgesics, and put under general anesthesia (monitored regularly by veterinary technicians). We split into two surgical teams: one working at the neck, the others at the legs (I was a part of team number 2). We started by exposing the femoral arteries in the legs (in the general region of the groin) and the jugular vein in the neck. My partner was being a bit of a hog (heh heh heh), so I didn't get to do much cutting here. But that's ok, because I made SURE that I got to step in at the part I was really interested in. So we exposed the artery, ligated it at the distal end, and then I got to place a freaking femoral catheter! Like, for realsies. It. Was. Breathtaking. Placing the needle, followed by a guidewire, then by the catheter itself; controlling bleeds and tying-off collateral branches...the whole experience was surreal.
After we had the catheters in place, we started with the experiment itself. First, we took some control measurements (again, heart rate, BP, etc.) with the pig in a normal state. Next, we were tasked with seeing how these would change under some, oh shall I say, bodily stress? So, we did what any normal person might do on an average, everyday afternoon: we bled the animal out. By 20%. Of its total blood volume. Holy cow, indeed, my friend. ...Err, well, close enough. Anyway, I think now you are beginning to understand my enthusiasm. So we made the measurements, yadda yadda yadda. And finally, we took the logical next step: we put the blood back.
So let me summarize for you. We made incisions into a leaving, breathing animal (so very, indescribably different from a cadaver, I might add. ...Very warm.). We worked diligently to expose the jugular vein and the femoral arteries. I got to perform my first cardiac catheterization. We took some measurements, filled a bag up with blood, took some more measurements, and then emptied that sucker right on back in. Whew. Unbelievable. Indescribable. Unforgettable...
Oh, but what am I forgetting? There was one other, small little detail. Ah, yes. So after this absolutely astounding series of events, we did one final thing. No big deal or anything, but, you know, we got to open up the chest cavity on one of the pigs. And look at a live heart. Did I say look at? Heh, oh no no no. I meant touch. That's right. Today, the 24th of February, 2011, I got to touch a live, BEATING heart. And it didn't stop there. I stuck my hand right on into that chest cavity, feeling around in all its glory. I got to push my fingers into living lung tissue (squishy!). I can't even describe how excited, how so very privileged this made me feel.
And then it got interesting.
Ha! I can practically hear you now. You are thinking to yourself, "Oh, surely he must be jesting!" ...Many things I am, but a jester I am not, my friends. So where could it have possibly gone from here, you ask? Well, let me tell you a few possibilities. First, the professor could have taken out an electrode and shocked the heart into atrial fibrillation. That's possible, I suppose. Oh, let's see. Next, he might have, theoretically, shocked it again, this time on the ventricle, sending the heart into ventricular fibrillation. Yeah, that could have happened. And oh, let's see, just to continue with the hypothetical, let's say the fibrillating heart may have progressed into ventricular tachycardia, and then into asystole (flatlined), at which point he would probably have shocked it back via defibrillation. Yeah, those things could have occurred. But surely not, right? That would just be WAY too cool.
I have to say, if touching a beating heart seemed like a once in a lifetime opportunity, I can't even begin to tell you what it felt like to touch a fibrillating heart.
And that, my friends, brings us to the conclusion of this chapter. Another incredible adventure in the exciting life of one extremely privileged (and as of late, bearded) protagonist. Before we part ways again, I will leave you with one final thought. As I was making my way to the lab today, I couldn't help but make an interesting (and dare I say astute) observation: I found it highly suspicious that our lab today took place right down the hall from the cafeteria...
...Ahem. That is all. Now please get out of my house. You're sitting in my favorite chair, and I require a nap.
*DISCLAIMER: I just want to assure anyone reading this that, although I make these jokes, all of the animals were treated with the UTMOST care and respect throughout the procedures, and were very humanely euthanized at the conclusion. Upon first hearing about this lab, I was a little taken aback by the thought of working on live animals, and even (briefly) considered not attending. But after today, I am SO glad that I did, and can honestly say that experiences like this are entirely unparalleled in their educational value.
