Today was a fanstastic day filled with tourism, exploration, learning and bewilderment. After breakfast, we promptly hopped in a cab, headed to the bus station, and began our journey to the town of Otavalo. I had heard many positive things about this town prior to coming to Ecuador; it is pretty famous among tourists for its open-air markets -- and for very good reason. The town is largely dominated by two sizeable street markets, one consisting primarily of foods, while the other (more renowned) boasts hand-made local Ecuadorian crafts. We stopped by the food market first. It had pretty much everything you might expect (fruits, veggies, grains, spices, various types of corn, etc.), as well as many thing that you probably would not -- such as whole boar heads, plates of lard (both cooked and uncooked), and tables full of other various and sundry body parts and entrails. As I walked through the crowded aisles, I couldn´t help but see the booths not in terms of the meats they were selling, but instead as an arid breeding ground for the variety of parasites to which they were certainly the host. Ah look, that woman is selling taenia solium -- anyone up for some cysticercosis? Oh, and look over here! A plate full of Taenia saginatum! A round of beef tapeworms for everyone! Despite the diversity of meat products, there wasn´t any fish to be seen, so my personal favorite, Diphyllobothrium latum, was conspicuously absent from the mix. In retrospect, I can´t help but think the only way a person could possibly get me to eat meat from that market would be if they served it up with an Albendazole glaze. But in all seriousness, though the meat section was a bit questionable, there were many fine looking products. The veggies and fruit stands were particularly appealing. Some of them had grapes the size of...well, I can´t really think of anything to compare them to, so we´ll just say they were the size of several normal-sized grapes. Nevertheless, they were large and looked quite appealing.
Next we hit up the crafts market, which was an even cooler experience, if slightly less hygienically remarkable. I won´t go into too much detail, but there were tons of incredible hand-made products. I bought a couple of great gifts, and managed to get them at some pretty ridiculously low prices following a bout of fierce (and impressive, if I do say so myself) haggling.
Finally, we spent the remainder of the afternoon checking out Jambi Huasi, a local clinic which combines traditional, indigenous practices with more occidental, western medicine. This was a really great learning experience. It was very interesting to see how they incorporated both (very distinct) styles into a single clinic. In addition to a medical doctor and nurse, they are also staffed by a partera (traditional midwife), and various other indigenous shamans and practitioners. During the course of our tour, they demonstrated two traditional techniques for us. I volunteered for the first one, which was performed by the partera. She essentially took two eggs and rubbed them all over my body in order to remove the negative energy. A rather tame demonstration overall, but interesting nonetheless. The next demonstration, however, was where things really got wild. Chris, one of my peers, volunteered for the following technique, which is typically used as more of a diagnostic tool than a treatment. It is called "limpia de cuy*", and is certainly not for the faint of heart, or for the avid PETA supporter (faint of heart, avert thine eyes). In fact, it was just about the most gruesome thing I have ever witnessed. The basic idea is this: the healer takes a guinea pig and rubs it all over the patient´s body. The negative molecules associated with their illness are thus transferred into the guinea pig, and the pathology can be determined thusly. We were told beforehand that the guinea pig always dies following the test: it is a necessary part of the procedure. I was prepared for this, but was still astonished at the manner in which the death took place. The healer started by holding the guinea pig by both ends and rubbing it gently over his body. However, as he progressed, he switched his grip, grasping it firmly at the midline, and started shaking it violently whilst continuing to rub it over Chris from head to toe. In case I´m not portraying this clearly enough, let me put it this way: he essentially shook the guinea pig to death. It started making squealing noises, and you could hear its head slapping back and forth. At one point it even urinated on Chris´ back. The idea is that the faster the guinea pig dies, the more negative energy the person has. Once it finally expires, the healer takes the animal, holds it over a bucket, and skins and eviscerates it on the spot. As he does this, he looks for various abnormalities -- since the molecules are transferred from the ill person to the animal, he is able to discern the pathology of the illness based on the location of the abnormalities. From this, a diagnosis is made, and the proper treatment can be administered. Apparently Chris has lower back pain, a recent mild bronchitis, and parasites.
So, in summary, I watched a guinea pig shaken to death while rubbed over someone´s body, skinned, gutted and discarded. What did you do today?
Now, I will be the first to admit that I viewed this entire procedure from an entirely different cultural perspective than those native to this area. I also realize that this is a traditional, indigenous technique that has been around for a very long time. And, even though there is likely no empirical evidence for the efficacy of this technique, let´s just assume for the moment that it does serve some diagnostic purpose. Great. With all of this considered, I still struggle immensely with the ethics of this procedure. It just seems so cruel. Again, I say this coming from an entirely different place culturally, and I can respect that. But still.
All things considered, today was an great day. Whether I agree with the technique or not, everything I saw today represented an incredible learning experience. I look forward to seeing more examples of how traditional and modern medicine are intertwined in this culture.
*Cuy is the word for guinea pig. If they don´t already have one, I am going to go ahead and put forth the motion to make Cuy the national animal of Ecuador. Not only are they utilized in the strange manner described in hopefully-not-too-gory detail above, they are also a traditional delicacy (yes, I mean food). Though I´m told they are rather fatty. Hm. Personally, I think I´ll stick with chicken and beef for my meals, and with xrays and bloodwork for my diagnostics. And while the egg cleansing wasn´t so bad, I think I prefer medications myself. But, to each his own.
Monday, June 27, 2011
Sunday, June 26, 2011
Day 1: A Thrilling Start
Here´s a rundown of day number uno. We started off the morning with breakfast and a logistics meeting, talking about the program, the clinics we will be working in, and our general itinerary. In the aftenroon, we did some exploring around Quito, walking around the quaint "old town". We had some lunch (tasty tamal de pollo), and then decided to head up to see the Virgin de Quito statue, which adorns a wonderful viewpoint overlooking the city. Pictures will come later but all I can say for now is this: Quito is huuuge. Astoundingly so. It seems to go on forever in every single direction. The city is like a giant bowl: completely flat in the middle with similarly sized buildings, surrounded by vast hills -- completely covered with houses -- which slope off into the distance. I think one of the reasons the city is so impressive is the sheer density with which it is packed full of buildings. It will be hard to do it justice with pictures, let alone with mere words (even despite my attempts at elegance).
Oh yeah. So we debated for a bit as to how we should get up to the viewpoint. Our guidebook said it was dangerous to walk, but a local told us we would be fine in a group at that time of day. So, we decided we would take the stairs to the top. Almost immediately upon reaching this decision, a fight broke out in the street among a group of locals, who promptly started picking up boulders and throwing them at eachother. The single policeman was utterly ineffective. Hmmm. On second thought...let´s grab a taxi.
Finally we visited the Basilica, a huge cathedral which absolutely dominates the view of the city, especially when seen from atop the viewpoint. It was beautiful from the outside. But it was the view from the top that we were really interested in. So, we payed our two dollar admission fee and started the long trek. We climbed stairs. Followed by ladders. Followed by more stairs. It just... oh wait, then came some more ladders. It just kept going and going. The view from each subsequent floor was more spectacular than the last. Upon reaching the top, we were astonished. It was breathtaking. An absolutely wonderful experience. The one downside was the sheer, unbelievable quantitiy of graffiti and writing debasing the walls. Sad.
It´s fun to just walk around the streets. TONS of people are walking about. There are people playing music, vendors with all sorts of delicacies (ice creams, pastries, and cool-whip-like dessert). There are loads of places selling incredible baked goods, which emit powerful aromas into the streets to entice hungry food-lovers over to the dark side of indulgence. Hmm, perhaps just one.
Oh yeah. So we debated for a bit as to how we should get up to the viewpoint. Our guidebook said it was dangerous to walk, but a local told us we would be fine in a group at that time of day. So, we decided we would take the stairs to the top. Almost immediately upon reaching this decision, a fight broke out in the street among a group of locals, who promptly started picking up boulders and throwing them at eachother. The single policeman was utterly ineffective. Hmmm. On second thought...let´s grab a taxi.
Finally we visited the Basilica, a huge cathedral which absolutely dominates the view of the city, especially when seen from atop the viewpoint. It was beautiful from the outside. But it was the view from the top that we were really interested in. So, we payed our two dollar admission fee and started the long trek. We climbed stairs. Followed by ladders. Followed by more stairs. It just... oh wait, then came some more ladders. It just kept going and going. The view from each subsequent floor was more spectacular than the last. Upon reaching the top, we were astonished. It was breathtaking. An absolutely wonderful experience. The one downside was the sheer, unbelievable quantitiy of graffiti and writing debasing the walls. Sad.
It´s fun to just walk around the streets. TONS of people are walking about. There are people playing music, vendors with all sorts of delicacies (ice creams, pastries, and cool-whip-like dessert). There are loads of places selling incredible baked goods, which emit powerful aromas into the streets to entice hungry food-lovers over to the dark side of indulgence. Hmm, perhaps just one.
The Beginning of An Epic Which Will Rival All Others, One With Which All Future Epics Will Ultimately Be Compared -- Part One: The Pilot With the Upside-Down Map (AKA Hasn´t This Guy Heard of GPS?)**
Greeting from Ecuador! I have arrived safely (though somewhat circuitously) in my destination of Quito. Though my ultimate arrival was as expected, the route I took to get here -- well, not so much. Let me explain. So I was on my final flight of the evening, purportedly heading from Panama City to Quito. The flight was supposed to take about 2 and half hours, and the expected arrival time was approximately 11pm local time. After flying for what seemed like some time, thoroughly engaged in some leisurely reading on my brand new Kindle (a must for all international travelers), I thought to myself: self, this flight seems to be taking a bit longer than expected, wouldn´t you say? When suddenly, almost as if in answer to my innocent ponderings, the an announcment was whispered over the speaker system. Seriously...whispered. for whatever reason, the captain of our plane literally, and quite frustratingly, whispered everything he said over the loudspeaker. I mean, comon man. I appreciate your attempts to make my travels a more intimate experience, but I´d really like to hear what you have to say -- especially when it is something to the effect of the following: DING -- this is your captain. The Quito airport is closed. We will be landing at the Guayaquil* airport instead. ...Um, what? Excuse me? Care to elaborate? No? Can you even do that!? I´m quite sure the destination on my ticket says Qutio!
Long story short, we flew all the way to the Guayaquil airport (I didn´t have a watch so I´m not sure exactly how long it took, but it seemed like at least an extra hour or so). Upon landing, we, the tired, confused masses, prepared to depart, when we were met by another delightful announcement. DING -- this is your captin. Please stay seated. We may be going to Quito afterall. ...Ahem. I...this...awesome.
In the end, we sat in the Guayaquil runway for what seemed like at least an hour and a half. Then we flew to Quito (another hour, perhaps?) We ended up arriving at 2:30 am, 3 and a half hours after our initial arrival time. After going through immigration and customs, I finally met up with Chris and Natalie (who seemed just as relieved as I was), at slightly after 3am. We hopped in a cab (here I am, for the first time! Looked to my right saw...oh hell, I dunno -- it was late.) and took a short ride to a local hostal where we stayed overnight. It it now 8:30 the next morning. I am waiting for the others (Chris, Natalie, and two with whom I haven´t yet been acquainted) to awaken for our breakfast, courtesy of the hostal. We will stay in Quito today, discuss the clinics, do some exploring, and stay here again overnight. I believe we head down to Tena tomorrow. The hostal has free WiFi and a computer (which I am currently using, in case you were wondering how I was posting this -- what is this black magic!?). So in any case, I should be able to respond to emails, blog comments or Facebook posts for at least the next day or so.
And so begins my amazing journey of absolutely epic proportions (Odysseus would be jealous). Though it started off a bit bumpy (it really wasn´t so bad -- more strange than anything), I made it, I am safe, and more than anything, I. am. STOKED. So please, keep in touch. I´ll update more when I can. This is going to be incredible -- I assure you: you won´t want to miss it.
*Ecuador has two major airports, one in Quito and one in Guayaquil
**I thought the length of the title should match the perceived length of my trip (as well as match, proportionally, the epicness of my adventure)
Long story short, we flew all the way to the Guayaquil airport (I didn´t have a watch so I´m not sure exactly how long it took, but it seemed like at least an extra hour or so). Upon landing, we, the tired, confused masses, prepared to depart, when we were met by another delightful announcement. DING -- this is your captin. Please stay seated. We may be going to Quito afterall. ...Ahem. I...this...awesome.
In the end, we sat in the Guayaquil runway for what seemed like at least an hour and a half. Then we flew to Quito (another hour, perhaps?) We ended up arriving at 2:30 am, 3 and a half hours after our initial arrival time. After going through immigration and customs, I finally met up with Chris and Natalie (who seemed just as relieved as I was), at slightly after 3am. We hopped in a cab (here I am, for the first time! Looked to my right saw...oh hell, I dunno -- it was late.) and took a short ride to a local hostal where we stayed overnight. It it now 8:30 the next morning. I am waiting for the others (Chris, Natalie, and two with whom I haven´t yet been acquainted) to awaken for our breakfast, courtesy of the hostal. We will stay in Quito today, discuss the clinics, do some exploring, and stay here again overnight. I believe we head down to Tena tomorrow. The hostal has free WiFi and a computer (which I am currently using, in case you were wondering how I was posting this -- what is this black magic!?). So in any case, I should be able to respond to emails, blog comments or Facebook posts for at least the next day or so.
And so begins my amazing journey of absolutely epic proportions (Odysseus would be jealous). Though it started off a bit bumpy (it really wasn´t so bad -- more strange than anything), I made it, I am safe, and more than anything, I. am. STOKED. So please, keep in touch. I´ll update more when I can. This is going to be incredible -- I assure you: you won´t want to miss it.
*Ecuador has two major airports, one in Quito and one in Guayaquil
**I thought the length of the title should match the perceived length of my trip (as well as match, proportionally, the epicness of my adventure)
Thursday, June 23, 2011
The End of A Journey, The Start of An Epic
Hello friends, family, and familiar followers. I apologize for the lapse in updates. I stand before you today a free man, recently released from my bonds of studying and homework, sauntering listlessly into what most refer to as the final summer of my adult life. In only a few short hours, we shall embark together, you and I (though really mostly just I), on the adventure of a lifetime. More details on that to come. But first, I will enlighten and entertain you with the juicy, highly sought-after details of the final few weeks of my first year of medical school. Oh, and while I know that I have said this countless times in the past, this time I really mean it: I'm going to keep this short.
1. My final course for the year, Biological Basis of Disease (BBoD), took me on a fantastical, whirlwind tour through the world of microbes, antibiotics, and parasites -- we spoke intimately of diarrhea (more frequently than one might have hoped), as well as various other types of intestinal assaults, including my personal favorite parasite, diphyllobothrium latum -- a human tapeworm which can grow up to thirty meters in length and can produce millions of eggs per day. Astounding. BBoD was a great course; where it lacked in organization it made up ten-fold in entertainment. I love this stuff. A career in infectious disease could very well be in my future.
2. My final preceptorship for the year was spent with a trauma surgeon. I worked weekly in the trauma clinic, where I worked with various doctors in addition to my actual preceptor. Trauma clinic was a nice change of pace from my previous preceptorships because I actually got to spend a bit of time seeing patients myself (though patience, it seems, is not a virtue highly touted by surgeons, so I was rarely able to spend more than a minute or two with any given patient). That was all fine and dandy, but here is the really cool part. Though I rarely worked directly with my preceptor in the trauma clinic, there were a few times she was around. There were two occasions where she got called in to do a surgery and, lo and behold, I got to tag along. But to my (and surely your) surprise, I wasn't only invited to observe the surgeries, but to assist in them. Hands on. Scrubbed in. Fitted with my very own pair of specially-sized surgical gloves. The first case: a splenectomy following a skating boarding accident. For this one, I didn't do too much myself -- mostly just held some organs out of the way. No big deal. But I was right there, in the action. As for the next case -- well, you'll hardly believe the details. I wouldn't have believed it myself had I not been there. Which I was. In the operating room. That's the whole point of this paragraph. Haven't you been listening? Guh. Anyway, the patient was an elderly woman who had "degloved" (it's a word, I promise. Google it if you don't beleive me. Actually, on second thought -- don't) her leg whilst moving a couch. The idea was to simply remove the excess skin (which was essentially completely torn off, knee to toe) and to clean things up. However, after consulting with a plastic surgeon (who had fortuitously been meandering about nearby), we decided to kick things up a notch. Why make this woman go through another surgery in the future to graft skin from her buttocks over the wound (a standard procedure, as I understand it)? Why not, instead, take the degloved skin, run it through a machine to turn it into a mesh, and then stick it happily back on her leg, right then and there? Why not? Because it's way too crazy cool sounding? Psh. That certainly didn't stop us. That's right folks -- I actually got to assist, hands on, with taking this freshly degloved, necrotic, dying skin, trimming it up, thinning it out, removing the excess subcutaneous tissue, running it through what I can only imagine is called a meshifying machine (things in medicine are always very aptly named), and reattaching that sucker right back on her leg (yep, I even helped suture it back on). And the best part? A few weeks later, the graft was almost a complete take. We ended up likely saving this woman another trip to surgery, and probably trimmed several days off the rear end of her hospital stay (and trimmed nothing off of her rear end). Pretty flippin' fantastic, if ya ask me -- which I'm just going to assume you did. Because I know you value what I have to say. Why else would you be here?
3. I mentioned a while back that I had been looking into various opportunities for this summer. Well, I finally decided on a trip, worked out all the details, and in just about 36 hours, will be hopping on a plane to have the summer of a lifetime. Here's a very brief rundown: I'm going to Ecuador to work in rural, government run clinics for four weeks. Afterwards, I'm going to travel around on my own for two weeks. First off, I'm going to hit up THE GALAPA-FREAKING-GOS ISLANDS, a destination that has been centered in my sights for many years. I'll be doing a 6ish day cruise around the islands, enjoying some sunshine, surf, and--assuming all goes according to plan--catching a ride on the back of a Galapagos tortoise. And for the final week -- I'll be doing a 4-5 day hike to the top of Machu Picchu. I. Cannot. Wait. And I think I'll leave it at that. I'm planning on updating my blog throughout the trip, so be sure to check back frequently so you can live this life-changing experience vicariously through me. I mean, let's be honest...what else have you got going on? Water balloons and lemonade stands? Psh-ah! We both know your time would be best spent reading about my wacky antics. I mean, turtle surfing? Come on! How cool is that? So don't disappoint me! Be here.
Well that's about it. Fast forward a few weeks, several tests and lots of studying, and here I am, the free man I described to you at the beginning of this long (dang it! I did it again!) post. Well, I'm calling it quits here for the day. Be sure to join us again next time as our dashing hero embarks on a journey of epic proportions. You won't want to miss this one. Stay tuned.
1. My final course for the year, Biological Basis of Disease (BBoD), took me on a fantastical, whirlwind tour through the world of microbes, antibiotics, and parasites -- we spoke intimately of diarrhea (more frequently than one might have hoped), as well as various other types of intestinal assaults, including my personal favorite parasite, diphyllobothrium latum -- a human tapeworm which can grow up to thirty meters in length and can produce millions of eggs per day. Astounding. BBoD was a great course; where it lacked in organization it made up ten-fold in entertainment. I love this stuff. A career in infectious disease could very well be in my future.
2. My final preceptorship for the year was spent with a trauma surgeon. I worked weekly in the trauma clinic, where I worked with various doctors in addition to my actual preceptor. Trauma clinic was a nice change of pace from my previous preceptorships because I actually got to spend a bit of time seeing patients myself (though patience, it seems, is not a virtue highly touted by surgeons, so I was rarely able to spend more than a minute or two with any given patient). That was all fine and dandy, but here is the really cool part. Though I rarely worked directly with my preceptor in the trauma clinic, there were a few times she was around. There were two occasions where she got called in to do a surgery and, lo and behold, I got to tag along. But to my (and surely your) surprise, I wasn't only invited to observe the surgeries, but to assist in them. Hands on. Scrubbed in. Fitted with my very own pair of specially-sized surgical gloves. The first case: a splenectomy following a skating boarding accident. For this one, I didn't do too much myself -- mostly just held some organs out of the way. No big deal. But I was right there, in the action. As for the next case -- well, you'll hardly believe the details. I wouldn't have believed it myself had I not been there. Which I was. In the operating room. That's the whole point of this paragraph. Haven't you been listening? Guh. Anyway, the patient was an elderly woman who had "degloved" (it's a word, I promise. Google it if you don't beleive me. Actually, on second thought -- don't) her leg whilst moving a couch. The idea was to simply remove the excess skin (which was essentially completely torn off, knee to toe) and to clean things up. However, after consulting with a plastic surgeon (who had fortuitously been meandering about nearby), we decided to kick things up a notch. Why make this woman go through another surgery in the future to graft skin from her buttocks over the wound (a standard procedure, as I understand it)? Why not, instead, take the degloved skin, run it through a machine to turn it into a mesh, and then stick it happily back on her leg, right then and there? Why not? Because it's way too crazy cool sounding? Psh. That certainly didn't stop us. That's right folks -- I actually got to assist, hands on, with taking this freshly degloved, necrotic, dying skin, trimming it up, thinning it out, removing the excess subcutaneous tissue, running it through what I can only imagine is called a meshifying machine (things in medicine are always very aptly named), and reattaching that sucker right back on her leg (yep, I even helped suture it back on). And the best part? A few weeks later, the graft was almost a complete take. We ended up likely saving this woman another trip to surgery, and probably trimmed several days off the rear end of her hospital stay (and trimmed nothing off of her rear end). Pretty flippin' fantastic, if ya ask me -- which I'm just going to assume you did. Because I know you value what I have to say. Why else would you be here?
3. I mentioned a while back that I had been looking into various opportunities for this summer. Well, I finally decided on a trip, worked out all the details, and in just about 36 hours, will be hopping on a plane to have the summer of a lifetime. Here's a very brief rundown: I'm going to Ecuador to work in rural, government run clinics for four weeks. Afterwards, I'm going to travel around on my own for two weeks. First off, I'm going to hit up THE GALAPA-FREAKING-GOS ISLANDS, a destination that has been centered in my sights for many years. I'll be doing a 6ish day cruise around the islands, enjoying some sunshine, surf, and--assuming all goes according to plan--catching a ride on the back of a Galapagos tortoise. And for the final week -- I'll be doing a 4-5 day hike to the top of Machu Picchu. I. Cannot. Wait. And I think I'll leave it at that. I'm planning on updating my blog throughout the trip, so be sure to check back frequently so you can live this life-changing experience vicariously through me. I mean, let's be honest...what else have you got going on? Water balloons and lemonade stands? Psh-ah! We both know your time would be best spent reading about my wacky antics. I mean, turtle surfing? Come on! How cool is that? So don't disappoint me! Be here.
Well that's about it. Fast forward a few weeks, several tests and lots of studying, and here I am, the free man I described to you at the beginning of this long (dang it! I did it again!) post. Well, I'm calling it quits here for the day. Be sure to join us again next time as our dashing hero embarks on a journey of epic proportions. You won't want to miss this one. Stay tuned.
Thursday, February 24, 2011
...And This Little Piggy Went Into Ventricular Fibrillation
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.
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.
Saturday, January 15, 2011
A Chance to Play Doctor
As a first or second year medical student, there is an overwhelming number of extracurricular groups and activities in which you can participate. These range from the rather customary, like student government, to the absolutely extraordinary, such as volunteering at actual free clinics. Let me clarify: when I say volunteering, I don't mean delivering food trays, stocking shelves, or greeting patients as they arrive. This is real, hands on experience...
...Essentially, it's a chance to play doctor, and we come fully equipped with our Fisher-Price play sets.
So two weeks ago, I had my first shift volunteering at SW Clinic, a community health center staffed by OHSU volunteers. Each shift runs from 4pm-8pm (or potentially longer, as needed), and includes an OHSU doctor, resident, and four first- or second-year medical students (that's me!). The clinic is open Tuesdays and Thursdays and serves about 20 patients per afternoon/evening.
And here's how things go down: we, the medical students, pick up the patient's chart from the front, call them back, take their weight, and room them. Next we take vitals (BP, RR, pulse), ask them about their chief complaint, and take a focused history. After we run through the whole procedure (completely on our own, I might add), we excuse ourselves from the room to go find the doctor or resident. With so many inexperienced students, the clinic tends to get a bit backed-up, so we often have to wait a few minutes at this point. Once the someone is available, we present our patient and discuss the assessment and plan (all according to our level of confidence and experience). Finally, we return to the room, this time accompanied by the doctor, to finish up the encounter.
And that's an evening at SW Clinic! Phew. It's hectic. It's overwhelming. It's nerve-racking. And it's absolutely thrilling. I cannot wait for my next shift. For the first time since starting medical school, I actually felt a bit like a real doctor; it was almost as if I could truly get a sense of my future career. And. it. felt. great.
The expectations of students at the clinic are a bit...humbling, to say the least. When the nurse was giving me my initial orientation, she continuously referenced tools, instruments and techniques, the likes of which I had never even heard of, let alone been responsible for myself. She even alluded to the fact that I might need to perform a Pap Smear, and thus showed me where to locate the tools to do so. I have to say, the first 30 minutes or so of my shift (up until the point that I finished with my first patient, really), were rather unnerving. Ok, let's be honest. They were terrifying. I felt so alone, so inexperienced, so out of place.
...And then, everything sort of clicked, and it felt completely natural (albeit still utterly foreign and confusing in just about every way possible). I loved it. And the best part? Every shift will be completely unique. Apparently one of my classmates, during his first shift at the clinic (which was during the very first week of medical school), did 2 Pap Smears and 3 prostate exams. Like I said, high expectations, huge responsibilities, exceptional experience.
The night of my shift, one of my peers pointed out that we were close to halfway through our first year of medical school. Based on this, he concluded that--assuming about a four year residency--we were 1/16 of the way to being useful doctors. And you know what? That night, for probably the first time since I started down this path, I actually felt useful. I was taking vitals. I was seeing patients. I was playing doctor. I was well on my way to my future career, with just half a year down, and many, many more to go. But that's ok. Because frankly, I was having the time of my life. With my Fisher-Price stethoscope in hand, I was one-sixteenth of a useful doctor indeed.
...Heck, I may have even been pushing an eighth.
...Essentially, it's a chance to play doctor, and we come fully equipped with our Fisher-Price play sets.
So two weeks ago, I had my first shift volunteering at SW Clinic, a community health center staffed by OHSU volunteers. Each shift runs from 4pm-8pm (or potentially longer, as needed), and includes an OHSU doctor, resident, and four first- or second-year medical students (that's me!). The clinic is open Tuesdays and Thursdays and serves about 20 patients per afternoon/evening.
And here's how things go down: we, the medical students, pick up the patient's chart from the front, call them back, take their weight, and room them. Next we take vitals (BP, RR, pulse), ask them about their chief complaint, and take a focused history. After we run through the whole procedure (completely on our own, I might add), we excuse ourselves from the room to go find the doctor or resident. With so many inexperienced students, the clinic tends to get a bit backed-up, so we often have to wait a few minutes at this point. Once the someone is available, we present our patient and discuss the assessment and plan (all according to our level of confidence and experience). Finally, we return to the room, this time accompanied by the doctor, to finish up the encounter.
And that's an evening at SW Clinic! Phew. It's hectic. It's overwhelming. It's nerve-racking. And it's absolutely thrilling. I cannot wait for my next shift. For the first time since starting medical school, I actually felt a bit like a real doctor; it was almost as if I could truly get a sense of my future career. And. it. felt. great.
The expectations of students at the clinic are a bit...humbling, to say the least. When the nurse was giving me my initial orientation, she continuously referenced tools, instruments and techniques, the likes of which I had never even heard of, let alone been responsible for myself. She even alluded to the fact that I might need to perform a Pap Smear, and thus showed me where to locate the tools to do so. I have to say, the first 30 minutes or so of my shift (up until the point that I finished with my first patient, really), were rather unnerving. Ok, let's be honest. They were terrifying. I felt so alone, so inexperienced, so out of place.
...And then, everything sort of clicked, and it felt completely natural (albeit still utterly foreign and confusing in just about every way possible). I loved it. And the best part? Every shift will be completely unique. Apparently one of my classmates, during his first shift at the clinic (which was during the very first week of medical school), did 2 Pap Smears and 3 prostate exams. Like I said, high expectations, huge responsibilities, exceptional experience.
The night of my shift, one of my peers pointed out that we were close to halfway through our first year of medical school. Based on this, he concluded that--assuming about a four year residency--we were 1/16 of the way to being useful doctors. And you know what? That night, for probably the first time since I started down this path, I actually felt useful. I was taking vitals. I was seeing patients. I was playing doctor. I was well on my way to my future career, with just half a year down, and many, many more to go. But that's ok. Because frankly, I was having the time of my life. With my Fisher-Price stethoscope in hand, I was one-sixteenth of a useful doctor indeed.
...Heck, I may have even been pushing an eighth.
In Case You Were Wondering...
...this should give you an idea as to the content of a routine medical school lecture:
"Alkaptonuria is a rather benign metabolic defect in tyrosine degradation that causes the patient's urine to progressively darken over time. ...I happen to have a sample of urine from a patient with Alkaptonuria that I've kept from several years back. I'll just let you guys pass this around."
"On the other hand, a much more serious metabolic disorder known as Maple Syrup Urine Disease manifests as a result of an inability to catabolize branch chain amino acids, and results in urine that is not only darkened, but also smells distinctly like maple syrup. ...I also happen to have a sample of urine from a patient with Maple Syrup Urine Disease that I've kept from several years back. I'll just let you guys pass this around. ....Oh, come on, nobody is going to smell it!?"
Medical school: filled with interesting facts and even more interesting smells. Don't forget the pancakes.
"Alkaptonuria is a rather benign metabolic defect in tyrosine degradation that causes the patient's urine to progressively darken over time. ...I happen to have a sample of urine from a patient with Alkaptonuria that I've kept from several years back. I'll just let you guys pass this around."
"On the other hand, a much more serious metabolic disorder known as Maple Syrup Urine Disease manifests as a result of an inability to catabolize branch chain amino acids, and results in urine that is not only darkened, but also smells distinctly like maple syrup. ...I also happen to have a sample of urine from a patient with Maple Syrup Urine Disease that I've kept from several years back. I'll just let you guys pass this around. ....Oh, come on, nobody is going to smell it!?"
Medical school: filled with interesting facts and even more interesting smells. Don't forget the pancakes.
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