Even with so much to do, medical students can still have a little fun. The last weekend I went to a house party, with drinking and silly stuff, then to a shooting range, then a BBQ and a turkey dinner, and then played computer games all night. It's nice to know that we can kick back occasionally, but we better enjoy it now, because it's going to get a lot worse. The number of drugs we need to memorize is steadily adding up - I wish I knew them all as well as I know drugs like tylenol or omeprazole, typical OTC drugs that I've known about most of my life.
We're getting into hypertension lectures, angina, coronary artery disease (CAD), congestive heart failure (CHF) and similar problems. It's funny, with all the talk about eating healthy, and how CAD can be seen as early as in teenagers or people in their twenties - the food I'm craving the most right now is fast food. I haven't craved it in ages, but here we are.
Every so often, the curriculum at our school throws in a "Managing Stress" class, where we are told ways to deal with stress, as well as the kinds of stress we are going to encounter (which of course gives us a lot of stress right then and there). Today, the doctor teaching the class was talking about how the first two years of medical school are a breeze compared to third and fourth years when you begin your clinical rotations and have to use whole different sets of skills (communcation versus booksmarts). Then she went on to say you think rotations are bad, wait til residency - where there will be hallways or stairwells essentially devoted to hiding and crying when your attending shouts the crap out of you. I imagine something like Dr. Cox from Scrubs, except no one is laughing. She then added how even then, you start your internship somewhere and it's just as bad - with more power comes more responsibility, which comes with more and more work. It's like being spider man except that everyone knows where you live and you're expected to work 16 hours straight.
As she talked about us being on rotations or in residencies, I couldn't help picturing how some of my classmates would be during rotations - getting picked on by the attending, or stepping into a patient room with an air of authority and asking them what the problem is and trying to help. Now that I know more about a doctor's thought processes, and my classmates' strengths and weaknesses, it is hard to picture myself as a patient of theirs - putting my problem in their hands and trusting their judgment. Though, in my mind at least, I always picture my classmates looking very proper, professional, and knowledgeable in these situations. I suppose that means I have a good amount of respect for my peers as future physicians and human beings (well, most of them - there's always a couple you wouldn't want as your doctor). Hopefully I'll pull everything together and become as awesome a physician as I picture most of my peers becoming.
Thursday, March 4, 2010
Wednesday, February 10, 2010
Studying, Advocating, Consoling...so much to do
Well, spring semester has been coming on fast and furious - been extremely busy. Have also had tests every other week, essentially, and our first Block exams of the semester are next week. We have had two standardized patient encounters with our small group - where we must take histories and perform a physical exam. It's amazing the things you notice yourself and your classmates doing when interacting with patients - strengths and weaknesses, the importance of listening... We have also practiced doing SOAP note write-ups (subjective, objective, assessment, plan) and worked on differential diagnoses. The ailments of the patients are in line with what we are learning, so we can apply what we learn clinically.
Tomorrow we get to explore a new aspect of the physician-patient relationship - breaking bad news. We will have 12 minutes to break bad news to a standardized patient who has been trained on how to react convincingly to the news, including shouting or crying. We will be faced with one of these: a son whose father unexpectedly died, a woman with a suspicious breast lump who needs a biopsy, a man with inoperable pancreatic cancer, a childless woman who just had a miscarriage, and a man with an STD from an affair. Should be interesting and nerve-wracking - but I imagine it will be more difficult for some of my colleagues than for me. Working in the lab, I definitely got to deal with very angry patients, and one woman I drew as a trainee had just learned her husband was going to die - that was a difficult one. You really don't know what to say to a stranger who suddenly starts crying, especially when they're still holding back so much pain and you know almost nothing about their situation. I almost cried myself that time - but sometimes all you can do is squeeze a person's hand to let them know you're there with them, even if it's for just a moment. I'm usually someone who insists on a 3 foot personal space bubble and never hugs people unless they're family (and even then not so much), but somehow I was able to recognize that at that moment, she really needed to feel physically that someone was there with her. If you're really with them, and not just going through the motion, time almost seems to stand still for you both in a good, or at least meaningful, way. They say, "You can touch patients during a bad news situation if you think they would be okay with it," and you kind of wonder, "How will I know if they would be okay with it?" Well, that was one of those moments, and I could definitely tell even with no experience - though my rule is that if in doubt, it's better NOT to touch.
On a more positive note, last Thursday we were bussed by the Osteopathic Physicians and Surgeons of California (OPSC) to the state capitol to speak with assembly members and fellows about the recent merger between the Doctor of Osteopathy and Doctor of Naturopathy boards. Essentially, bill AB X4 20 merged the boards because the governor wanted to make it look like he was cleaning up the government - busting excess bureaucracy and saving money. However, both our boards are funded by those in the profession, no tax money is involved, and they approve licenses as well as oversee malpractice issues. NDs do not prescribe medications without supervision (and even then, no category 2 drugs) nor do they perform surgeries - so having them oversee us, or even have us oversee them, is not fair to either profession. I was the designated group leader to the assembly member whose fellow we spoke to because apparently I live within the district (14). Definitely nerve wracking, but everyone seemed to think I made a very eloquent case. The fellow we spoke to seemed very supportive of our cause. One of the senators (Lee) has submitted two goldenrod bills to his boss for approval, which we need in order to get numbers on them, support, and signatures. It was really enlightening to see how the process works in state government, and that people in the offices actually will listen to you and you can make a difference. We also got to speak to one of the governor's aids right before he was going to a meeting with Mr. Schwarzenegger himself, with the promise of at least mentioning the issue with him, so that was exciting. There were a bunch of school children outside of the governor's offices as we walked in and they were all asking us to say "Hi" to the governor for them, ask for more money for schools, it was adorable. All in all, a very exciting day - here we all are in front of the capitol building!
Tomorrow we get to explore a new aspect of the physician-patient relationship - breaking bad news. We will have 12 minutes to break bad news to a standardized patient who has been trained on how to react convincingly to the news, including shouting or crying. We will be faced with one of these: a son whose father unexpectedly died, a woman with a suspicious breast lump who needs a biopsy, a man with inoperable pancreatic cancer, a childless woman who just had a miscarriage, and a man with an STD from an affair. Should be interesting and nerve-wracking - but I imagine it will be more difficult for some of my colleagues than for me. Working in the lab, I definitely got to deal with very angry patients, and one woman I drew as a trainee had just learned her husband was going to die - that was a difficult one. You really don't know what to say to a stranger who suddenly starts crying, especially when they're still holding back so much pain and you know almost nothing about their situation. I almost cried myself that time - but sometimes all you can do is squeeze a person's hand to let them know you're there with them, even if it's for just a moment. I'm usually someone who insists on a 3 foot personal space bubble and never hugs people unless they're family (and even then not so much), but somehow I was able to recognize that at that moment, she really needed to feel physically that someone was there with her. If you're really with them, and not just going through the motion, time almost seems to stand still for you both in a good, or at least meaningful, way. They say, "You can touch patients during a bad news situation if you think they would be okay with it," and you kind of wonder, "How will I know if they would be okay with it?" Well, that was one of those moments, and I could definitely tell even with no experience - though my rule is that if in doubt, it's better NOT to touch.
On a more positive note, last Thursday we were bussed by the Osteopathic Physicians and Surgeons of California (OPSC) to the state capitol to speak with assembly members and fellows about the recent merger between the Doctor of Osteopathy and Doctor of Naturopathy boards. Essentially, bill AB X4 20 merged the boards because the governor wanted to make it look like he was cleaning up the government - busting excess bureaucracy and saving money. However, both our boards are funded by those in the profession, no tax money is involved, and they approve licenses as well as oversee malpractice issues. NDs do not prescribe medications without supervision (and even then, no category 2 drugs) nor do they perform surgeries - so having them oversee us, or even have us oversee them, is not fair to either profession. I was the designated group leader to the assembly member whose fellow we spoke to because apparently I live within the district (14). Definitely nerve wracking, but everyone seemed to think I made a very eloquent case. The fellow we spoke to seemed very supportive of our cause. One of the senators (Lee) has submitted two goldenrod bills to his boss for approval, which we need in order to get numbers on them, support, and signatures. It was really enlightening to see how the process works in state government, and that people in the offices actually will listen to you and you can make a difference. We also got to speak to one of the governor's aids right before he was going to a meeting with Mr. Schwarzenegger himself, with the promise of at least mentioning the issue with him, so that was exciting. There were a bunch of school children outside of the governor's offices as we walked in and they were all asking us to say "Hi" to the governor for them, ask for more money for schools, it was adorable. All in all, a very exciting day - here we all are in front of the capitol building!
Also, on one final note, the founder of Touro University, Bernard Lander, last night at the age of 94. All the Touro campuses were closed out of respect. I don't really know what to say about it, as I never met him or knew much about him before now, but I am kind of wondering how it will affect the universities. At the least, I was productive and used the day to get more caught up on classes.
Sunday, January 24, 2010
Latest in Whiteboarding
Well, I'm trying to catch up on all my anatomy, but more will certainly follow - I need to work on respiratory material that we're starting to learn, put up some OMM diagrams, and maybe some useful doctoring notes. As we go, though, I feel like there's material we already learned that is slipping away from me! It is so much material, I'm definitely going to have to do some studying over the summer somehow - I hate that I try to remember stuff from first semester and some of it is already disappearing. Tomorrow is Monday, which means 8 hours of lectures, so I have to be sure to bring a decent sized lunch. Also, there's a basketball game between our class (2013) and the second years (2012) - hopefully it will end better than the last game between our classes...
Apologizes for the quality - I have not yet found a decent way to photograph my whiteboard
Wednesday, January 20, 2010
Post-Mini CVRR Exam...
Well, since the last post, so much has been going on that I haven't had the right state of mind to study...what with the first week of school and seeing everyone, coming back from winter break, and having a party/Gala packed weekend. So, alas, my studying last week was essentially nonexistent and very little studying was accomplished when I visited Kit over the weekend, so I ended up doing an all-nighter last night and I am feeling the pain right now. Anyhow, hopefully tomorrow I'll wake up feeling more energized and be able to charge back into studying!
We've been getting into more detailed cardiovascular exams, dissecting the heart, learning about the heart and various ways of looking at circulation. We're starting the respiratory system now but I want to go back over the circulation stuff a bit since I feel like I probably missed some of the details during my rabid speed studying last night. Hopefully will be having some normal fun this weekend, make some headway on my studies, and feel all prepared for next week.
We've been getting into more detailed cardiovascular exams, dissecting the heart, learning about the heart and various ways of looking at circulation. We're starting the respiratory system now but I want to go back over the circulation stuff a bit since I feel like I probably missed some of the details during my rabid speed studying last night. Hopefully will be having some normal fun this weekend, make some headway on my studies, and feel all prepared for next week.
Thursday, January 7, 2010
Awesome Anatomy Lab!
Sometimes you have a really fun time learning things - when you get quality time with professors, they don't seem rushed, and you have prepared, you can get really involved in the active learning process. We had small groups today, and were examining the inner thorax, mediastinum, the lungs, and the heart. There are so many knowledgeable professors, it's great! Also, all the information was being absorbed in my head like a sponge, and becoming more cohesive.
Some of the highlights include finding essentially all of the key terms we needed, learning how to insert a tube through the rib cage to remove air or fluid, following the arteries and veins into and out of the heart, and getting information about x-ray films of the chest. This was quite a fun lab. It also helped my studying - I updated my whiteboard. I barely have any room left for tomorrow's material, or the heart stuff from today, but nothing we focused on today was particularly new. Unfortunately there were a lot of graphs, so I probably need to memorize and understand those...
Some of the highlights include finding essentially all of the key terms we needed, learning how to insert a tube through the rib cage to remove air or fluid, following the arteries and veins into and out of the heart, and getting information about x-ray films of the chest. This was quite a fun lab. It also helped my studying - I updated my whiteboard. I barely have any room left for tomorrow's material, or the heart stuff from today, but nothing we focused on today was particularly new. Unfortunately there were a lot of graphs, so I probably need to memorize and understand those...
Tuesday, January 5, 2010
Week 1 Has Begun!
Well, Week 1 is well underway, starting the cardiovascular system. We opened up the thorax on Monday, peeled away the skin on the chest, saw the pectoralis major, pectoralis minor, serratus anterior, external intercostales, deltoid, subclavian muscle. Also the rib cage, the sternum, manubrium, clavicles, etc. I also dug around and found the subclavian vein, cephalic vein, axillary vein, axillary artery, and brachial plexus. Next we took out the ribs (bone saw) and observed the lungs, heart (still in pericardium), a bit of the trachea, etc. One of the other cadavers had severe lung cancer - he had bulges the size of golf balls on his lungs and the interior of his ribs were black on that side. There was also a male cadaver with breast cancer. On one of the cadavers I was able to see the right and left vagus nerves and the left phrenic nerve also.
I have been making good use of my new giant blackboard - as for OMM we have started the pelvic area, learning landmarks, anatomy, and lateralization tests. I'm glad I had a girl partner for the first one - I'd rather not feel stuff for the first time on a guy - least now I know what to look for and won't feel like I'm groping around their crotch and butt aimlessly. The science lectures are all about how the heart works, mostly action potentials right now - which I have learned multiple times - AP biology, then cognitive science 1, 10 and 11, then in some biochemistry classes as well, and now here. At least I have some fun stuff planned for the end of the week - a party and the shooting range. Seriously, medical school is way more fun than undergrad was! Oh, and also my disbursement check is ready at the financial aid office - I need to get it tomorrow and figure out my budget for the Bolivia trip - if I have some extra money, I may go to Convocation. If not...well, there's always next year.
Saturday, January 2, 2010
Spring Semester...
Monday is the first day back at school, and I am not particularly looking forward to it. I just got rid of my year-long writing block so now I want to work on that! Alas, it will have to be put aside. It looks like we're starting in on the cardiovascular system, and will be dissecting the chest wall, the heart, etc. I don't really want to go back to the anatomy lab... One more weekend to enjoy freedom before entering the grind of school again. I won't have a break again until spring break, and then not until I get back from Bolivia. I think I'm going to pass on Convocation this year, simply because I already have one expensive trip planned. Maybe next year I'll go. Anyhow back to enjoying the last break I have for months...
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