Charlie goes to Medical School

Snake on a Cane

When I was 11 or 12, I had to go to the dermatologist.  I think this was the time I went because I had a rash of unknown origin.  My mother took me to see a dermatologist that we knew through church who informed us that what I had was in fact poison ivy.  I had apparently picked it up at the Boy Scout Klondike Derby somehow.  We didn’t think anything of it because I was only out for the day and in cold weather gear, but I had apparently picked some up on my hand and transferred it to my ankles or had gone through some pretty tall brush while running around.  It was no big deal, as a scout I eventually gotten enough poison ivy rashes that I eventually stopped reacting to it.

This was my first time at the dermatologists and not too happy about having a rash during my pre-teen “this is the end of the world” years.  However, once in the office I was immediately put  at ease by a grumpy old physician who was complaining about having to sit through the third Godfather movie and how they should have just stopped after the second one.

I thought this was hilarious.  Of course, I was 11 or 12 and did not fully understand what a travesty the third Godfather movie was.

I had to go back a few times while growing up, and I really enjoyed seeing him.  He and his family were also very involved with our youth group at church.

When I got accepted into medical school, I was told that this doctor actually had done his residency at my new school, and I was excited to have a connection like that with my new school.

This morning, he passed away after a lengthy battle with cancer.  He was given 4-6 months when he was first diagnosed.  He fought it, full of what I’m sure was piss and vinegar, for a year and a half.  The last I heard from him was that since he was on oxygen 24/7, he was going to put together a marine based crime-fighting unit to protect the citizens of community.

He will be missed.

When did your first notice that you were a clinic room? by Brittany G

Our first test is over with, and I am pleased with how it turned out.  We have moved on in our fundamentals unit continuing into topics having to do with biochemistry, molecular biology and development.  These classes are going well and I am comfortable with the material especially since I covered a lot of it in my post-bacc coursework.  On the other hand, our clinical course has gone into a field which I really don’t have any experience, interviewing patients.

A week ago, we had our first mock interview session.  The school of medicine here has its own patient rooms which are specifically designated for teaching the students in a simulated clinical environment.  Our first mock patient interactions were with classmates acting as the patients.  The purpose was not to actually gain any information from the interaction, but to practice building a rapport with a patient.

The lesson from lecture earlier that week dealt with the techniques involved in putting the patient at the center of the interview and allowing them to drive the conversation, and we were getting a chance to do that.  A  doctor must facilitate the conversation in such as way that he can document a patient interaction methodically while still putting the patient at the center of the conversation.  This is done in part by starting with very broad questions and getting around an issue (clarifying, describing) before drilling down with more detailed questions (the specifics).

Sometimes in this conversation, silence is your friend (as the doctor, not the patient).  And sometimes, all it takes is a slight nudge to get a patient into a place where they can describe what is going on.  At the very base of this interaction is a rapport that must be built quickly that can enable the conversation to happen.

This week, our clinical lecture actually started getting into the information that doctors use when diagnosing a patient.  So what is the information that a doctor gets?  Well, I’m going to hold off on that until a later post so I can focus a little more on the specific data that is to be gathered from an interview.

I will tell you that for each encounter between an doctor and a patient, it will depend.  Experienced doctors working with a specific patient concern may not go into every part of a full history.  As a student, however, I will be expected to go into full detail with each patient and the present the entire history to a physician before they perform a physical exam.  With experience, you learn what pieces of information can be important while diagnosing a specific concern.  However, all of the information is relevant.  If you go into the doctor’s office with a cold, you might not be asked for a full history which is why you should have regular physicals done to cover everything with your doctor.

I’m looking forward to more training and practice, but I do have a lot of work to do in preparing for interactions with our standardized patients (i.e. actors) and with actual patients in the hospital.  Lecture and classwork has always been easy for me, especially since in science the grade is always objective.  Interviewing patients on the other hand is much more subjective and will require an amount of work on my part to get proficient at them.  I’m really looking forward to it.  Until then, I can always practice in front of the mirror.

http://www.flickr.com/photos/brittanyg/ / CC BY 2.0

Larynx, Darrynx and Darrynx by Olek Remesz

Today was the first meeting of the Wilderness Medicine Interest Group at my particular medical school.  The group gets together for outings for biking, kayaking, repelling, etc.

They also discuss wilderness medical procedures.  Wilderness medicine is considered to be procedures performed while two or more hours away from medical facilities.

In Scouts, we referred to this as first aid, but today was well beyond applying pressure.  In fact, I’m more than a little hesitant to mention anything about how to do the procedure.  Please don’t try this out on anyone for fun.

A cricothyrotomy is a temporary solution for when emergency care is not immediately available.  In a medical facility a tracheotomy (lower down) would provide a more reliable airway, but is a little more difficult and leads to more bleeding.  There is quite a bit of bleeding with a cricothyrotomy, but at that point you are mostly worried about airway and breathing (i.e. A and B before C).

(Quick Note from Commenter Evan: You don’t want to break skin unless absolutely necessary two hour out from ALS. If you are in situations where you are far from medical assistance, breaking the skin like this will cause a situation where you then have to control bleeding until help arrives and there is always the risk – more of a guarantee in these situations – of infections.  This is a trade off that you are making to get the airway open when nothing else will work.)

Our speaker showed us a video describing the proper method for performing the procedure, should you have the appropriate equipment.  He then described the procedure without the kit.  One notable loss is that in the wilderness you will likely not have a ventilator or a bag-valve.  This means that this procedure will not help if the individual cannot breath on their own.  It will only give you an open airway.  Additionally, since the procedure is providing an open airway to the neck, this will only help for an upper airway obstruction.

Then, once we had discussed the procedure, the group went outside where the wilderness group had set out pig throats for us to practice on.

I donned my protective gloves and wielded a scalpel long enough to shove a 1/4″ tube into the larynx/trachea of a deceased pig.

It…

was…

awesome.

I still have a long way to go before I get to do any real medicine or procedures, but I can tell you this.  I was speaking with a fourth year student at one of the Welcome Week events about the clerkships during the third year.  What he was telling me was that experiences widely vary and that a lot of it is based on you telling the doctors how much you want to do.  Apparently some students hold back during their third year.  If you want to get involved (And some students don’t.  Some are looking for more clinical/office work.), then you need to get used to putting it out there…that you want to do as much as possible.

For some reason, this reminds me of the time that I went bungee jumping.  I went out onto the ledge and was going to tell the extremely nice gentlemen that I needed a second after having a towel loosely wrapped around my legs followed by harness webbing.  I was going to ask for a second right when he looked straight in my eyes and yelled “FIVE, FOUR,…”

Before he got to three I thought to myself that there was no way I could be on the ledge when the gentlemen who pushed people off bridges got to zero.

At this point, I cannot tell you what went through my head between three and zero, but I did jump.

Since I was sharing a pig neck with two other students, I was hesitating.  But only enough to be polite to them.  I just couldn’t wait to get in there and make the first cut.

The Anatomy Lesson of Dr. Nicolaes Tulp by Rembrandt van Rijn

The test went well today.  I already know what I made, but I won’t be sharing that here.  I grabbed lunch in the hospital with quite a few people who were hanging out after the test was done.  This afternoon was a lecture on taking histories.  Half the class bailed on this lecture (since it was after the test) which is unfortunate because I thought the lecturer did a wonderful job going through the information.

I’m pretty psyched about doing patient histories in the weeks coming up.

I biked the waterway home.  It was much drier this time, so I was able to get much farther.  The path pretty much dumps out on a road that goes straight into my neighborhood.  This made for a nice extended ride home.  When I got home, I found some of my classmates throwing a frisbee in the street, so it turns out that I have more classmate neighbors than I realized.  There is also apparently a party tonight, so Wife and I are going to try to track that down for a bit tonight.

Since we had a Monday test, there is little time to recoup before we start up again.  Gotta make use of the downtime while I can.  Everyone have a good evening.

Fortune by KellyK

Study study study.  Study, study study study study study study study study-study study.  Study study study study study study, study study study study study.  Study, study study study study study study study study study study study study study study study?

Study.

Study, study, study study study.  Study study study study study study, study study study study study.  Study, study study study study study study study study study study study, study study study study study.  Study study study study study study study study study study study study study study study study study study study study study.

Study.

This study break has been brought to you by the Charlie goes to Medical School Study Group with support from the Study Foundation and study like you.

In addition to stuff from the first week, we have gotten into mitotic and meiotic division, DNA replication, repair and recombination, and gene expression/protein synthesis.  Oh, and the first two weeks of embryonic life.

Making the cards was a little much this go around, but I’m not ready to give up on them yet.  Over the material for the next test, I will be working to keep flashcards up each day.  That should give me more time to review them during the lead up to the exam.  Especially since the next exam is on a Friday and I will not have a weekend for studying immediately preceding the exam.

I feel pretty good about the material, but I am still a bit unsure just because this is my first test in medical school.  We’ll see how it goes.  The test is tomorrow morning.

Alright, I’m already spending more time on this that I should.  I’ll see you guys on the other side.

http://www.flickr.com/photos/elasticsoul/ / CC BY-SA 2.0

Sorry for the lack of posts this week.  I meant to post something on Wednesday, but got a little slack and then had to make up my study time that night.  Yesterday was busy.

Monday and Tuesday had some interesting cross-theme action going on.  For our clinical class we had a lecture on communication in the context of a patient interview.  Tuesday, I had a small group which had a discussion based on acclimating to medical school.  There were a lot of points brought up in each lecture.  However, both brought up an interesting common point which was mindfulness.  The lecturer on Monday went a little more into of a formal explanation of it (i.e. being mindful of what you are presently doing) where it was used as a counterpoint to, say, multitasking.  On Tuesday, it was more of an undertone of a introduction by our small group facilitators who made us sit in silence for two minutes and then asked us how much quiet time we gave ourselves each week.  I shared that I rode my bike too and from school every day, and that I usually just think about the bike ride when I’m doing it.

And whistling.

Wednesday, was studying and slacking most of the afternoon/evening.

Yesterday, I had lunch with my mentor, an ill-advised trip home where minimal studying occurred, a hasty return trip to school for a review session, and a quick evening out with Wife for dinner before heading home and making it an early night.  The dual trips to school were nice as exercise, but I didn’t get settled in to study for very long.  This will probably get better as I get into better shape and the ride home isn’t quite so taxing.  However, I also have the library on campus to study in as well.  I’m going to eventually find a nice balance of studying and school and studying at home.

I also lost my sunglasses yesterday, so I’m a little mad about that.

Today, we had a university-wide event where all of the health profession students got together and attended a series of presentations.  These presentations covered a variety of topics.  It was a very nice event and it got us out of lecture for the morning.

I also had clinical lab today for the first time.  We did interactions with other students pretending to be patients, and practiced opening up a interview with a patient.  Eventually this will lead to us taking histories from actual patients, but for now we are just practicing setting up for the actual interview.  At one point today, clinical lab was interrupted by a fire alarm.  When my group got outside, we found each other and briefly discussed our activity’s disruption.  At this point, I turned to one of my classmates and as if I were taking a history I said, “And when did you first notice the fire alarm going off?”

One other thing I picked up on is that the clipboard they gave us was really getting in the way of my interaction.  At first I was trying to write stuff down, which eventually failed.  At the end, it was something else to fidget with so I put it in my lap halfway through my last interview and then just talked with my patient.  I think once I actually have to start taking histories, I am going to have to work on that.  I will need to take notes during a history, but I do want the interaction with the patient to come first before taking notes…or playing with the clipboard.  Eventually stuff like this becomes second nature.  I’d like the good patient interview habits to be the thing that becomes second nature, so I’m making sure that I work on this.

Monday, I have a test.  I allowed myself the night off yesterday, because this weekend it is going to be go time.  I’ve been making flashcards all week, and almost finished making them for all of the lecture the material.  There are actually quite a few, and I may only be able to go through the cards a few times.  However, at this point I’ve written the notes twice and forced myself to take a hard look at almost everything.  I’m comfortable with the material.  We’ll see how the rest of the weekend goes.

Well, I’ve survived my first week of medical school.

So far, I’ve learned about amino acids, proteins and enzymes.  I’ve learned about lipids, membranes and membrane transport, specifically glucose and amino acid transport…so far.  I’ve learned about nucleic acids and nucleotide base metabolism.  And, I’ve learned about professionalism, in the context of case studies involving ethical situations/dilemmas and in the context of an oath that I will swear in a month.

I’ve been asked a few times what classes are like.  First off, they are four hours long.  Sometimes, they are six to eight hours long if you include afternoon activities two, three days a week.  And you don’t care.  You learn about a semester’s worth of material in about two to four weeks.  What I learned this week would be a major test’s worth of material in an undergraduate course.  And it seems completely normal…and I know it is only going to get faster.

The difference in the material coverage, is that the focus is less academic.  The tests we will be taking are based on recent updates to the USMLE Step 1 Exams.  The updates to the boards are based on the reality that everything you learn in the classroom during the first two years of medical school must eventually be applied.  So, the course covers the bulk of the material needed (biochem, molecular bio, cell bio, physiology), but the lessons are completed through vignettes and case studies which demonstrate the topics that we are covering both on the tests and in the lectures.

The first day of class, we learned about amino acids and their role in determining the structure and functions of proteins.  This past Friday, the CDC MMWR released a dispatch which demonstrates the resistance to antivirals.  This resistance is believed to be associated with a substitution of an amino acid on the neuraminidase surface protein of the Novel Influenza A (H1N1) Virus.  The structure and function of this surface protein was altered by the substitution of one amino acid resulting in a drug resistance for the virus.

And so, I’m 5 schools days into this.  I’m also halfway through the material for my first test.  I’ve already started making flashcards (eventually, I may not even have time to do this).  Next weekend will be primarily purposed for booking it, and next Monday I’ll be tested on what I’ve learned so far.  This week, I will be preparing and making sure I properly cover the lecture material from this week.  In a week, we will see how I am doing.

One thing I haven’t posted about is Welcome Week.  I don’t actually have time to post anything because we are going to something here in a bit and I have to fit in dinner ahead of time.

The short version is that the second years have thoughtfully planned out a week plus of activities which have been thrown for the first years.  This has allowed us to get to know the town a little bit as well as each other.  The first years have had classes together for a week at this point, but I still don’t know a lot of the second years.  So this is good for networking.  This has also been a good chance for Wife to meet some people in her new city.

Anyway, I’m cooking some rice to go with precooked pork that I fixed last weekend.  Then off to get some litter for Admin Cat and our last social event of Welcome Week.  I hope everyone had a good week.  It was very, very, very great for me.

Thanks again to everyone who helped get me here.  And thanks to all you blog readers out there.

Bike Trail by wheany

So, I took a quick detour on my way home from school today.  It was brilliant.  There is a waterway trail here which is, at places, of some dodgy construction and also, at other places, has no real view of the waterway.  However, it was a fun way to get home and a really nice place to ride.

Also, it was completely out of the way as I didn’t know where I was going.  So as I took a street I was familiar with, it dropped me off practically back at school, and I then had to go back up the hill.  Next time I will know how to get back another, shorter way which will be a bit easier on me and give me more time on the waterway.

It did take a bit longer than I had realized, so this won’t be a daily trip home kind of ride.  However, every other Friday when I have off, I will probably hit the waterway to get a good longer ride in to end my week.

It’s also dawning on me that I should get a picture of the bike up here.  It looks pretty nice even with the rust, although it did look a little better after hosing off the dirt from the ride.

http://www.flickr.com/photos/wheany/ / CC BY 2.0

Lifehacker is doing a Back to School series of posts.  I’m not sure that skipping class is advisable, but cheap books are.

The GTD for students post is what caught my eye to the series.  I tried to read this book a while ago and got stalled out on it while studying for tests in post bacc.  Time management is definitely very crucial for those going (or trying to go) to medical school.  I’m not the biggest fan of the whole GTD methodology, but it is worth checking out if you feel like your organizational skills need a tweak.