Monday, December 7, 2009

Endocrinology rocks.

One advantage about the way my preclinical curriculum is set up is that it is very similar to college.

Most med schools will put you in a bulimic state of learning: you spend a solid month in one class, learning all of human body's anatomy for example. You spend days memorizing every aspect of every piece of tissue until you start dreaming about it. Then come test time you have to vomit it all up. Repeat for every class, and it is a wonder we remember anything at all.

However, my days are spent learning all of the subjects at once by systems. Right now I am looking at butts and genitalia. I get to know everything about it: histology, anatomy, physiology, etc. I should know everything doctors know about how the body is when nothing is broken. I think it is great because everything is skillfully woven together, and I do not have to learn all about the hand in one day, then revisit it months later. The best part is that we get to keep the same professor for the whole subject, instead of the usual parade of PhD's needed to sustain a solid month scheduling for one subject.

I particularly love the endocrinology. The professor is pretty popular for several reasons, a great approach to teaching and a light British accent that all makes us swoon in particular.

Today, he proved he is also a gift to mankind by serving as the right hand of GOD, destroying rare diseases left and right. How so, you ask? Well we had a special session in class today, where he brought in two patients affected with diabetes. I won't go into too much detail, but basically one patient was recently afflicted with diabetes. That was the easy part, bread and butter cases for endocrinologist such as our professor.

The hard part was that the patient was had a extremely extremely rare form of diabetes. For months the patient was confined in the ICU while her blood sugar levels raced between record breaking highs, then record breaking lows. After her clinicians exhausted all options, including injecting ungodly levels of insulin to fight off the wave of sugar in her blood, our professor tried a specific anti-inflammatory drug.

It worked. In fact, it worked so well the patient was completely off any diabetes medicine when she spoke to our class. It turned out the patient had type 1 diabetes that attacked late in life when it really only shows up in kids. That kind of diabetes happens when your own body utterly renders the cells that makes insulin dead to the world, leaving none that can help you keep your blood sugar down. It is as if you want to go through a door that you have a key for, but someone stuffed gum into hole, so in frustration you keep jamming your key into the hole trying to get in. Our professor simply took out the gum, in one smooth stroke, with just one drug.

Now that is thinking outside of the box.

Tuesday, November 24, 2009

Thanksgiving is. So. Close.

Something going around that really struck me...






I am thankful for the teenagers who are complaining about doing chores -- that means they are home and safe.

... for homework. It means we live in a country where education is valued and encouraged for all.

... for the taxes I pay; it means I have income.

... for the mess that I have to clean up after parties, because it means I am surrounded by friends.

... for the clothes that fit a little 'too snug' because it means I have enough to eat.

... for the lawn to mow, windows to wash and gutters to clean; it means I have a home.

... for the parking spot I found at the far end of the parking lot, because it means I am capable of walking and am blessed with transportation.

... for my huge heating bill, because it means I am warm.

... for the person behind me in church that sings off key, because it means I can hear.

... for the pile of laundry and ironing, because it means I have clothes to wear.

... for all the complaining I hear about the government; it means we have freedom of speech.

... for the alarm that goes off early in the morning because it means that I am alive!

Author unknown

Friday, November 20, 2009

Tankmate!

Check out this post from my tankmate about our very first day in anatomy lab.

This is sort to make up for my dearth of posts during that critical time of my life. Let me know if you want to hear more about anything!

PS - This is what you've been missing out on:

http://streetanatomy.com/2009/10/26/hello-anatomical-kitty/

Wednesday, November 18, 2009

Quitting

Quitting. I thought about it today.

A big soft-skills final exam is coming up, and I feel totally unprepared. I mean yes, I know how to do a brief history/physical exam already, but not the "full" one that allows physicians to explore the full spectrum of disease a patient might have. My exam consisted of the ABC's - is your Airway open? Good. Can you Breath? Even better. Do you have a Circulation? Dandy. That's the big idea for medics out in the field.

But now, I actually need to be able to feel for splenomegaly, and listen for heart murmurs. What? My preceptorship is in the highest socio-economic strata of this part of the state. Before I even started my preceptor visits, he warned me on the phone that I might not be able to do as much as I could.

At the time, I brushed it off, thinking my previous experience would be fine. So up until today, I half-assed my visits. I played along, and thus became complacent. I didn't get any chance to practice skills that will enable me to detect diseases and tease out differential diagnoses.

As test time got closer and closer, I started to panic. My classmates started to catch up to me, and I realized I had gotten rusty. Some of them had preceptors that let them loose, and as a result they learned and learned about the most fundamental skills a physician should be perfect at. Soon, jealousy took hold, and I wanted to defect to perhaps another preceptor site. It was rare to do so, but it is possible. For example, one of my classmates was assigned to a gastroenterologist. When she needed to learn how to take vital signs, all of her patients just needed to get scoped.

I walked into the pediatrics clinic today, I mentally took a deep breath. It was the last visit of the year. Maybe forever. So let's make the most of it, I thought. If I piss off some anxious parent fussing over their trust fund kid...screw it. I need to learn, so that I can help scores of future patients.

I just kept jumping in all day, and surprisingly, no one stopped me. It reminded me of when I first realized what I could do as a supervisor EMT, leading a team at a major rollover accident. I just did it.

At the end of the day, my preceptor had a simple visit, but had grown up with the patient's grandfather. After almost six decades of friendship, my preceptor's friend passed away the same year as his wife, only a couple years ago. Everyone in the room teared up except for me when this was brought up. My preceptor had such a enduring bond with the families of his patients. It just took me a semester to realize it. My biggest lesson yet.

I'm not going to quit. I can still get a lot of learning experiences here, and my preceptor isn't some concierge physician catering to the rich and famous. He has taken care of many PARENTS of the patients here, and is a pillar of the local community here. I can learn so much from him, and I am going to stay.

Tuesday, November 17, 2009

Rectal Intercourse

We learned in histology today why rectal intercourse is not as great as it was made out to be.

Your anal canal is what meets the outside, and has nice thick layers of cells that prevent HIV and other bugs from invading your body. Now, one inch into the colon...you get to the rectum. Now, that is only one cell layer thick. I would imagine it is easier for HIV to cross that than...let's say through regular vaginal intercourse. So that's a no-go fellas.

The whole time, the professor kept interchanging "rectal intercourse" with "butt @#$(."

Oh he knows what he is doing. Every time he uses the colloquial, he immediately follows with, "that's not funny!" You can imagine how hard it was for the class today to maintain composure.

Sunday, November 15, 2009

Haunting

Beautiful, beautiful prose. I hope what happened to her never happens to me, but I bet it will, over and over.

That said, Critical Care sounds more appealing every day...

Sunday, November 8, 2009

Frustrated

I am frustrated. Once a week I go to a clinical skills class to learn how to perform a history, physical exam, etc. For a long long time, the course consisted of a group of students getting together with a faculty preceptor to talk about mushy stuff such as empathy and the importance of a "patient centered" interview. Yeah, yeah.

The EMT in me was thinking well that is nice, but what if you have a mentally unstable patient or a lovely GSW (gun shot wound) and blood is everywhere and you NEED a quick, effective report YESTERDAY?

For a month I was either bored out of my mind, or teaching my classmates how to draw blood, take vital signs, etc. However, the game changed recently, and caught me unaware. New territory began to pop up, such as cardio-pulmonary examinations. The material suddenly exploded, and I have pretty done a 180. Now it is REAL DOCTOR stuff, and all of the sudden I am struggling to keep up.

I got my wish. I am still frustrated. Now for completely opposite reasons.

Saturday, November 7, 2009

David Watts

Dr. David Watts is incredible. He wears many hats: professor of medicine at UCSF, gastroenterologist, writer, and frequent contributor to NPR. I will remember him as the first person to completely captivate me for almost two hours straight. Dr. Watts delivered a talk on humanism in medicine as the featured speaker for an annual tradition honoring a tragically murdered student at my med school. Faithful follower(s) of this blog- I now have no excuse to let this little window into my life as a med student fall into disrepair.

Keeping one foot in the world of scientific medicine while another foot firmly rooted in literature, he is an example that not only is it possible to achieve balance, but that honest reflection indeed is essential for sanity. I am sorry for taking a year off from this blog- at the very least I need to scribble down more than just my anatomy journal. Dr. Watts is completely correct- no other time in my life will ever compare to the journey I am on now.

Dr. Watts read out powerful vignettes with a quiet eloquence that gave an understanding strength to his message. The patient physician bond does not have to be destructive for either party. Third year medical students do not have to become proficient at emotional wall-building. The unique patient-physician relationship is actually enriching, even rejuvenating. The road I am on is already such a lonely process, I don’t need to wall myself up or tend to the just the science of medicine. This is a human process full of messy human relationships. To sum it all up- “Without science, we are quacks. Sometimes with it, we are still quacks.” –David Watts, MD

Wednesday, October 7, 2009

Gossip

So as a reminder, I'm a first year medical student.

I was sitting in study area reading one day when one of our faculty mentors comes in to replace our snack cabinet. After she leaves, I email out to the group of mentees under her wing that we had vittles again to munch while pondering the positively elegant musculature of the arms and legs.

Roughly 5 minutes after I send out that email, I see several second years poke around the cabinet like a raccoon in a dumpster.

I love how fast info/rumors/gossip spreads in med school.

Friday, September 18, 2009

Hi there

Yep it's been awhile.

I'm starting up blogging again, because the sheer weight of ideas and posts I've written up makes my computer want to go on a diet. I'll be nice and publish them slowly in bite sized bits.

I've also decided to shift the direction of this blog. Back during undergrad, I was a feisty and angsty little EMT, unsure about life and what was going to happen to me.

Well I got into medical school. Yeah, no kidding. Crazy, huh?

It is a fantastic med school, where I am having a TON of fun. Of course I study all day now and that's all I do, but boy do I have random tidbits to share. (Someday I will gather enough of this tidbits to be a useful doctor. Perhaps.)

For example, did you know kittens can cause acute carpal tunnel syndrome? Yeah! So there are these things called tendon sheaths, that surround the connections between your hand muscles and your hand bones. When you play with kittens, they will inadvertently poke your with their sharp sharp claws, creating microscopic holes in your hand. Germs can get into your tendon sheaths from those holes, and spread back all the way to the carpal tunnel of your hand near your wrist.

The thing is you won't notice these kitten inflicted microscopic holes at all!

Crazy huh?