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.
Thursday, February 24, 2011
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.
Friday, December 17, 2010
A Much Needed Rest
I'm going to keep this brief (for real this time).
I just got home from my second exam in CSF, the completion of which marks the beginning of my two week winter vacation!!!! Now, I've obviously had breaks like this before; I've been through demanding courses, taken big exams. I've even had whole weeks of tests for undergraduate finals. Yet I can honestly say that I have NEVER felt this excited, grateful, and utterly RELIEVED to go on break before today. Like the almighty Atlas on the day the Earth comes to an end, I feel like a huge weight has been lifted off my shoulders. These last few weeks in CSF have been long and exhausting. We started in on biochemistry during the latter portion of this block; while it was definitely nice to get back into familiar territory (this was the first time since the start of med. school that we have studied something that I have learned previously), the sheer extent of information was vastly overwhelming. The material that we covered during the first two days of the biochemistry section--that's a total of just eight hours of lecture--was literally equivalent to what I learned in an entire 10-week term during undergrad. And that was just two days. We had another week of biochemistry to follow, not to mention the week and a half of histology that we had already suffered through. My head has never felt so jam-packed with cell types, tissue features, enzyme reactions, etc.
...But it was fun. And I'm super excited to be studying biochemistry (which we will cover exclusively in this class from here on out). And so far, I've been impressed with how much I have forgotten, but ASTONISHED with how fast it has come back. Next block is going to be another intense one, but I'm looking forward to it. But for now, all I'm looking forward to is a wonderfully relaxing two weeks of relaxing, reading, snowboarding, eating, video games and family time. Speaking of family, I'm just about to kick it all off by heading over to Mom/Dad's for what will surely be an incredible movie night. Could this get any better? ...Wait, what? IT'S ALMOST CHRISTMAS?! Why, that's my favorite holiday! And you brought me eggnog? You shouldn't have! And, are those cookies I smell my roommate baking this very moment? They most certainly are! Man... Life. Is. Goooood.
I just got home from my second exam in CSF, the completion of which marks the beginning of my two week winter vacation!!!! Now, I've obviously had breaks like this before; I've been through demanding courses, taken big exams. I've even had whole weeks of tests for undergraduate finals. Yet I can honestly say that I have NEVER felt this excited, grateful, and utterly RELIEVED to go on break before today. Like the almighty Atlas on the day the Earth comes to an end, I feel like a huge weight has been lifted off my shoulders. These last few weeks in CSF have been long and exhausting. We started in on biochemistry during the latter portion of this block; while it was definitely nice to get back into familiar territory (this was the first time since the start of med. school that we have studied something that I have learned previously), the sheer extent of information was vastly overwhelming. The material that we covered during the first two days of the biochemistry section--that's a total of just eight hours of lecture--was literally equivalent to what I learned in an entire 10-week term during undergrad. And that was just two days. We had another week of biochemistry to follow, not to mention the week and a half of histology that we had already suffered through. My head has never felt so jam-packed with cell types, tissue features, enzyme reactions, etc.
...But it was fun. And I'm super excited to be studying biochemistry (which we will cover exclusively in this class from here on out). And so far, I've been impressed with how much I have forgotten, but ASTONISHED with how fast it has come back. Next block is going to be another intense one, but I'm looking forward to it. But for now, all I'm looking forward to is a wonderfully relaxing two weeks of relaxing, reading, snowboarding, eating, video games and family time. Speaking of family, I'm just about to kick it all off by heading over to Mom/Dad's for what will surely be an incredible movie night. Could this get any better? ...Wait, what? IT'S ALMOST CHRISTMAS?! Why, that's my favorite holiday! And you brought me eggnog? You shouldn't have! And, are those cookies I smell my roommate baking this very moment? They most certainly are! Man... Life. Is. Goooood.
Friday, December 10, 2010
Life is Like a Box of Prostates...
We kicked off the new term in PCM last week learning how to perform breast, prostate and gynecological exams. They started off the class informing us that we would not, in fact, be practicing on each other as we had when learning previous physical examination skills (oh what a shame). Instead, we would use a series of very expensive, somewhat lifelike models.
As if performing these exams on lifeless, fleshy-plastic figurines wasn't weird enough, the models had a particular feature (or lack thereof) that made the experience even stranger: they were completely cut off both above the waist and below the knees, like some Old Navy commercial gone horribly wrong: "OK, Bill, put the cute dog with the Christmas sweater over there, aaaand let's go ahead and have the talking mannequins stand right over here, right next to the running wood chipper. Yeah, yeah, right there. Perfect.".
It was really quite the sight. The classroom was filled with these truncated teaching aids--dismembered, yet strangely anatomically correct--on which we spent the good part of an afternoon performing finger-orifice explorations. In addition to the models, we had some other fun learning aids as well. At one point we passed around a single, fleshy, lifelike breast in order to practicefeeling palpating ("now I'm going to feel your breast, ma'am") for lesions. There were six lesions total in this particular breast model; we were instructed to employ to the aptly named "lawnmower" pattern in order to ensure a thorough examination (gotta catch 'em all!).
But my favorite part of this is-this-seriously-happening-in-real-life? afternoon wasn't the shaming of pelvic amputees; nor was it the disembodied breast, the dangling testicles, or even the bag of scrotums (about which our professor actually said: "hey, you don't happen to have any scrotums over there, do you? Oh, you do? Great. Could you toss me one"). No, in thinking back, my favorite part of this laughably educational day was, without question, the box of prostates. It was a small, white box, housing six heart-shaped prostates of various sizes, colors and consistencies. At first glance, it might even have been mistaken for something one might receive as a Valentine's gift, or perhaps as a token of apology after a particularly distressing argument. In fact, the over-sized, discolored one (prostate #4, I believe) even had a light-brownish tint to it, giving it a distinct caramel-like appearance (dulce de próstata, anyone?).
They were arranged in neat little rows--the prostates, I mean--each more interesting than the last. And so we passed the box down the line, taking our turn at trying to commit to haptic memory the difference between the feel of spongy, healthy prostate from that of hypertrophied, tumorous one. And though I will likely soon forget these tactile distinctions, the memory of this ridiculously outlandish day will forever remain. In fact, I'm sure it has already been stored safely away in my memory vault--filed appropriately under "P", for prostate--right along with other favorites like M:milking bowels, D:disarticulated heads, and S:skullcap removals.
But never fear: I was sure to leave some room in the vault for the many more wacko, mysterious adventures that are surely to come. For if my medical education thus far has taught me anything, it's that life truly is like a box of [prostates]: ya really never know what you're gonna get.
Let's just hope it's not cancer. ...Or coconut.
As if performing these exams on lifeless, fleshy-plastic figurines wasn't weird enough, the models had a particular feature (or lack thereof) that made the experience even stranger: they were completely cut off both above the waist and below the knees, like some Old Navy commercial gone horribly wrong: "OK, Bill, put the cute dog with the Christmas sweater over there, aaaand let's go ahead and have the talking mannequins stand right over here, right next to the running wood chipper. Yeah, yeah, right there. Perfect.".
It was really quite the sight. The classroom was filled with these truncated teaching aids--dismembered, yet strangely anatomically correct--on which we spent the good part of an afternoon performing finger-orifice explorations. In addition to the models, we had some other fun learning aids as well. At one point we passed around a single, fleshy, lifelike breast in order to practice
But my favorite part of this is-this-seriously-happening-in-real-life? afternoon wasn't the shaming of pelvic amputees; nor was it the disembodied breast, the dangling testicles, or even the bag of scrotums (about which our professor actually said: "hey, you don't happen to have any scrotums over there, do you? Oh, you do? Great. Could you toss me one"). No, in thinking back, my favorite part of this laughably educational day was, without question, the box of prostates. It was a small, white box, housing six heart-shaped prostates of various sizes, colors and consistencies. At first glance, it might even have been mistaken for something one might receive as a Valentine's gift, or perhaps as a token of apology after a particularly distressing argument. In fact, the over-sized, discolored one (prostate #4, I believe) even had a light-brownish tint to it, giving it a distinct caramel-like appearance (dulce de próstata, anyone?).
They were arranged in neat little rows--the prostates, I mean--each more interesting than the last. And so we passed the box down the line, taking our turn at trying to commit to haptic memory the difference between the feel of spongy, healthy prostate from that of hypertrophied, tumorous one. And though I will likely soon forget these tactile distinctions, the memory of this ridiculously outlandish day will forever remain. In fact, I'm sure it has already been stored safely away in my memory vault--filed appropriately under "P", for prostate--right along with other favorites like M:milking bowels, D:disarticulated heads, and S:skullcap removals.
But never fear: I was sure to leave some room in the vault for the many more wacko, mysterious adventures that are surely to come. For if my medical education thus far has taught me anything, it's that life truly is like a box of [prostates]: ya really never know what you're gonna get.
Let's just hope it's not cancer. ...Or coconut.
Tuesday, December 7, 2010
Health Care Haiku #2
Haiku number two, for you (woo hoo!)...
Histology lab:
where else could you hear things like,
"Hey, hand me that (non-keratinized, stratified squamous epithelialized) skin"
Sunday, December 5, 2010
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