Saturday, October 23, 2010
Being a 3rd year medical student like being an awkward teenager starting high school: You don’t quite know how to fit in, you’re trying to become more independent without overstepping your bounds, and you get lost easily in a new environment. Remember what it was like to be a teenager? At times you do very “grown up things”—learn to drive a car, vote for the first time, take care of making dinners some nights, for example. Yet while you’re testing out your boundaries, you still get reprimanded, you still live in your parents’ home, and you likely are not making enough money to support yourself, so you still have to play by your parents rules.
Life on the wards is very similar. As a medical student, we just learned all this medicine during our first two years so we feel like we know a lot, but at the same time, compared to the nurses/interns/residents/attendings, we know so little. We walk into rooms at 5 in the morning to talk to patients, take their histories, do physical exams, answer questions we know the answers to, write notes in the chart. A few minutes later, the nurse/intern/resident/attending do the exact same thing. These activities are very “grown-up” yet there’s that constant feeling of not knowing if you’re doing the right thing, or that you’re playing pretend since everything you do is done again, and usually better. It’s easy to get reprimanded, easy to get lost or feel lost, and we still have to play by the rules.
It’s pretend, but at the same time, medicine is a field where you’re always making an impact on someone’s life whether you want to or not. We have the remarkable privilege to ask patients intimate questions, perform physical examinations, and to our astonishment at times, patients let us. As “in-between doctors” we have the unique ability and time to translate what is happening to patients throughout their hospital course, and why things are happening the way they’re happening. Though it may seem from our vantage point that the white coat, stethoscope and scrubs feel awkward and like we’re playing pretend, many patients do not feel that way. To them, we’re just another health care provider waking them from sleep to ask them if they have chest pain, shortness of breath or if they’ve farted yet. The best part about it, is that your real responsibility is to try on the shoes of each specialty and learn without danger to the patient. It’s awkward, but it’s the best thing ever.
Monday, February 8, 2010
You would think that school studying and boards studying is the same. In some ways yes, and in many other ways no. For me, school studying is learning all the intricacies that specialists in their field want us to know, and boards studying is pattern recognition. School studying is staring at packets of notes and PowerPoint slides, and boards studying is doing questions from a Q bank that make you feel like you haven’t learned anything in the past 1.5 years.
One of my colleagues and I joke when we see each other in the dark isolated recesses of the BioMed basement that we’re like monkeys: trained to memorize and spit out information. We’re all a little neurotic the way we study. Some like their packets stapled, some need them unstapled. Some highlight every word in the notes packet as they read, and then highlight them again in a different color when they read it again—rinse and repeat. Some (me for example) write and draw diagrams on the whiteboard and erase them—rinse and repeat. Still others put things on Post-it notes and put them all over their bathrooms and kitchens (imagine walking into that house). Unless you’re in it, or have done it, this all seems CRAZY. The relief/justification/satisfaction comes when we see patients, and we recall that sticky note with the differential next to the toothpaste to the left of the shaving cream, or that drug that’s highlighted in 5 different colors to the point that it’s almost illegible, and we’re able to help a real, living person.
This weekend, I took a break. It was all getting a little too nutso, and let’s be real, it was way more fun snowboarding on Saturday, watching the Saints win the Superbowl with friends (the commercials were terrible this year), and watching a couple movies on Netflix. It’d be great to be as smart as House, know the diagnosis right off the bat and just mess with your team because you can. It’d also be amazing to be one of those doctors (What are they anyways? It seems like they must be quadruple boarded in interventional radiology, surgery, internal medicine and infectious disease, while doing lab stuff on the side). Maybe it was endless studying that made House into the ridiculously brilliant jerk he is on TV. If that’s the case, I think I’d rather not know as much, and be a friendlier doctor. Don’t people say 70% of medicine is being able to talk to and relate to your patient?
For now, I have some ideas what I want to do, or rather, what I think I don’t want to do, but little experience to base it on. The experience is coming though, and I’m pumped. For now, it’s continuing to be a monkey, memorize and spit out facts, and recognize patterns. The satisfaction’s just on the horizon. A few more months, and we’ll be working long hours in the hospital—probably wishing we were back studying, in control of our own schedules.
Saturday, January 2, 2010
Someone once told me that studying for the boards is the best/worst thing you’ll never want to do again. That sounds pretty accurate. Though I’m not looking forward to the “intense 6 week study period” that we have, I’m excited for the outcome. This is a period of time when second years synthesize all of the information we’ve learned so far into something that’s usable. It’s our time to organize the vast amount of knowledge we’ve learned (and forgotten already), and package it into a usable form. The thought of being able to think of a McDonald’s #1 and the number of things a 2nd year student could tell you about what happens to that as it passes through our body astounds me. It’s incredible that after only a year and a half, most 2nd year students can tell you the gross anatomical route the food will take down our body, the innervations, blood supply and musculature of those structures how it’s absorbed and digested, what enzymes and chemical mediators are involved, and the different interactions between organ systems from a gross to a cellular to an enzymatic (sometimes even genetic) level. The more I learn, the more I want to know (though it always seems like there’s too much to know before a test). The more I learn, the more I realize I still have to learn. It all seems so daunting, but it’s both inspirational and comforting to know, that practicing physicians have all gone through a period of time like this in the past and have made it through.
4 months of crazy studying, and then the wards—the part of medical school that I’ve been looking forward to the most.
The interesting thing that I’ve heard from many people in medicine, during different times in their careers is that you’re always looking forward to the next step. 1st and 2nd year med students look forward to their 3rd and 4th years when they’ll be rotating, 3rd and 4th years look forward to residency when they’ll have more responsibility, and residents look forward to finally finishing their training and becoming an independent doctor. It’s sometimes hard to enjoy the moment, but I think it’s important to always remember how fortunate we are to be going into such a wonderful career. Each struggle / obstacle along the way is just one more step in the right direction.
Thus far, we’ve studied cardiology and renal this year. I was thinking about how funny it would be to compare medical student “buzzword results” to those of “normal people.” Last week during small group, bread and butter came up, and the first thing that came to mind wasn’t breakfast or English tea, but pericarditis (because we’ve been told multiple times that pericarditis looks like bread and butter on the gross level).
As medical students and future physicians, we’re encouraged to sharpen our observational and deductive reasoning skills—after all, isn’t that how clinicians diagnose patients? What’s the most common cause of hypertension in a 76 year old man with high blood sugar? You put hypertension, an elderly man and high blood sugar together, and I spit out diabetes and nodular glomerulonephritis. As future clinicians, these buzzwords will rule our lives.
For me, I sometimes find myself so entrenched in medical school that I forget what it’s like to think about anything other than medicine. Since we recently studied renal, I’ve noticed that my thought pattern has changed. Usually when people feel the urge to urinate, they think of where the nearest bathroom is. Last week, I found myself tracing the nerve pathway of my detrusor muscle in my bladder back to my brain which was causing me to realize that I needed to pee. As I was relieving myself, it wasn’t the normal satisfaction that comes with peeing that was occupying my thoughts, but I found myself thinking about the pathway of urine from the glomerulus in my kidney all the way to the urinal cake in the bottom of the urinal.
Like most of my “problems” in medical school, I turned to my medical school friends to see if they had any similar experiences or if I truly should see a psychiatrist / psychologist to discuss my inability to separate medicine from every day life. The responses I got back varied from, “Whoa, you might want to chill out a little,” to “Oh my gosh, I last night I had a dream me rafting down a urine stream in a giant nephron last night!”
Reflecting on the variation of responses from various friends and family members, the same conclusion I get from everything else comes to the surface. Balance: it’s something everyone strives for, and few truly achieve. Many people in this world yearn for normalcy at one point or another in their lives. The truly successful are those who can achieve it at some extent.
This summer, during my cross-country bike trip, my good friend Jake gave me a piece of advice about balance. He said that the happiest people he knows who are established in whatever field that might be—law, medicine, business, art—have balanced lives. When he asked them about how they achieved balance in their lives, they said that they didn’t sacrifice the things that made them happy during their training. Prioritizing “balance” from the beginning will make it easier to maintain balance later on in life. This is the true test in medical school. Yes, our renal test was 41 pages, 3.5 hours and 120 questions long—a pretty serious test by anyone’s standards—but the true test, is achieving balance in the face of the behemoth of knowledge we’re required to learn.
My hope is that I can achieve this balance in life so that words like bread and butter bring to mind English breakfast tea and biscuits when I’m not studying instead of pericarditis.
Monday, October 5, 2009
Medicine, like all sports teams, has a certain rite of passage that one must go through before being accepted as a part of the "team." Learning the medical interview is the first step of initiation. The basic History and Physical (H&P) has been used by physicians for centuries. It's a systematic way of figuring out what's going on. It's a way to listen to the patient's side of the story (the subjective) and then test your hypothesis for what the patient might have with the physical. Every doctor learns the order of this interview along with all the abbreviations. CC, HPI, PMH, FH, SH, Nutrition / Sexual history (they don't have an abbreviation because oftentimes they're omitted because they're not as pertinent to the case), ROS, PE. In our first year, we learned how to take a history. We could do it in our sleep. Now, we're learning how to put it all together with the physical exam.
An integral part of the doctoring class is the 1st and 2nd year mentors. Us students go to a doctors office or hospital and shadow practicing physicians and see real patients. We put our memorized checklists to use and ask all the questions. The challenge this year, is to learn what questions to ask and when. More than that, it's to know what parts of the physical exam to perform based on the patient's presenting complaint. This year, we're supposed to put it all together--all the stuff we learned last year, the history and the physical exam. It's a daunting task, but we'll be on the wards in May, so I speak for myself when I say that I'm feelin' the pressure.
My mentor, an ER physician in Massachusetts, is helping me realize all the things I have yet to learn by constantly "pimping" me. Pimping, is something that will happen to us for the rest of our careers. It's how your superiors tell if you're smart, and how well you're understanding what's going on. I feel like it's also a way of them showing off how much they know and how little you know. The way it goes is they'll ask you questions, usually until you get one wrong. For me, it's making me realize how little I know even though we've taken so many courses, and how much I have yet to learn. It's a great way to learn, but again, it's putting the pressure on.
One thing I've had to get over is the very concept of a medical student or a resident. Medicine is something you learn over a long period of time. It takes time to store and be able to recall all that information. There's always going to be a first time for medical students and residents--whether that's performing a procedure or asking a question or giving bad news. Before, I thought about what I might do if someone in my family got sick. Would I let a medical student or a resident make decisions / do procedures for/on him/her? Now that I'm a part of the system, I've encountered so many kind and generous patients who have graciously let me poke around, listen to their hearts and lungs (at first in the wrong and then in the right places and positions), push on their bellies, shine lights into their eyes etc. As a patient myself, or a family member, I might get annoyed by a medical student doing all sorts of things to me / my loved on.
A nice elderly couple last week in the ER made me think about my own biases. The woman was in for stomach pain, and the husband was there by her side. I asked her if I could take her history, and then my mentor came in and watched me perform a belly exam (after he had taught me last week how to do it on another patient) and then present my findings to him. The woman was so kind. She let me proceed and the whole interview and PE took longer than it would have had my mentor done it all. Afterwards, the couple asked me where I was in school, how I was liking it, and if I knew what kind of doctor I wanted to be. They told me about their daughter who was in her 4th year at another medical school (I forgot what kind of doc she wants to be). We had a brief conversation and as I was leaving I thanked the woman for letting me take her history and examine her. She replied, "You've all got to learn on someone. My daughter learned from all sorts of patients, and I'm happy to contribute to your medical education as a way of giving back to the medical community."
The encounter made me think about my own biases and practices. I'm going to the doctor tomorrow for a regular check up, and like the woman from last week, I'd be happy to help contribute to someone's education. If there's a medical student / resident there, I'll be happy to let them interview me / do a physical. We all have to learn somehow.
Tuesday, September 22, 2009
In medical school, I've found that with each new disease process / illness we learn about, I think I have it, or I think I know someone that has it. After just finishing the cardiology block, I thought I had a big left ventricle in my heart. One morning, I woke up, thought my heart felt funny (I was probably just hungry), so I put on my stethoscope and had a listen. Stepping back, it was a weird thing. I was in the bathroom brushing my teeth after just getting out of bed, looking in the mirror to make sure my stethoscope was in the right place, listening to my heart. As I listened more, I thought I heard an extra beat. Thinking back to what I had studied and learned a few days earlier, I knew that sometimes you can hear an extra beat. Normally, everyone knows of the "lub dub" sound. But sometimes there can be a "lub dub-dub" sound. It the "dub-dub" part gets longer when you breathe in due to pressure changes in the chest increasing blood flow, thus changing the amount of blood that's in your heart, changing the timing of closure for two of the valves. Anyways, that's normal. What's "not normal" in people over 40 is when you hear "lub-lub dub," which is what I thought I heard. That sound, the "lub-lub dub" is indicative of a bigger left ventricle (the workhorse of the heart). Now, I swear, cardiologists say they can hear the difference, and so can I when I listen to the heart beats on a CD or online with the diagrams or EKG playing along with the sounds. Listening to the real thing is different though. It's quite a bit harder. So after freaking out a bit, listening to my heart, convincing myself I had a big left ventricle due to biking across the country (I felt like an awesome athlete), I then thought I heard a murmur (telling me I had a leaky valve). AHHH!!
There's only one thing to do when confronted with a situation like this: go to the doctor... a real one. Well, thank God I'm surrounded by tons of real doctors. I had my cardio small group leader, a cardio fellow @ RIH take a listen. The results: no murmur, and normal "splitting of S2 (when you breathe in, the "dub" turns into "dub-dub")." Relieved I was able to concentrate again.
Cardiology was great. I liked it a lot. The test? Not sure. I normally don't finish quickly, and this time I finished super fast, checked my answers a few times and then still with lots of time left and the normal speedsters still in the room, I couldn't take it anymore and left. So does that mean I don't know my stuff, that I studied a lot and did well, or that I totally missed the boat on a bunch of questions? We'll find out in a week or so.
Off to a dentist appointment and then the ER to shadow.
Till next time.
Sunday, August 30, 2009
This summer was exactly what I needed. For a lot of my classmates, summer consisted of staying in Providence and doing research, or travelling abroad as part of their scholarly concentration, or some activity related to medicine. Instead of focusing on medicine all summer, I decided to ride my bicycle home (from Providence, RI to my home town of Los Gatos, CA). I needed something for myself. Something I would cherish forever. Something to break the monotony of continuously studying or working since before high school (summers included). This being the infamous “last summer” (third year starts in May), I figured it was ok to be selfish. It ended up being one of the best decisions I’ve made so far.
In high school and college, I had come across Joseph Campbell’s writings on the importance of a young man’s rite of passage a few times. One of my favorite movies, Motorcycle Diaries, depicts Che Guevara riding his motorcycle from Argentina up to Venezuela during medical school. Combining Joseph Campbell’s ideas of a young man’s rite of passage, my past traveling experiences in Latin America and my adventurer spirit, hitch-hiking through Central or South America seemed perfect. Convincing my folks to let me do it, or recruiting friends to come with me was difficult (to say the least). Instead, I opted to explore my own country in a unique way while challenging myself physically (versus mentally, which is what I had been doing all year).
First year med school trained me to follow routines. Wake up, breakfast, school, eat, school, exercise, eat, study, sleep… rinse and repeat. Everyone has his/her own routine until the week before an exam when everything goes out the door and nothing else matters but cramming as much information into your head as possible.
This summer, I still had a routine, which was comforting, but it was completely different than what I experienced throughout the year. Wake up, break down camp, pack my bags, get on my bike and ride, eat lunch, get on my bike and ride, eat dinner, get on my bike and ride, set up camp, go to sleep… rinse and repeat. It was the comfort of routine without the stress of medical school. It was perfect.
Now that I’m back in Providence, my medical school routine has started again, but it seems different for some reason. After seeing so much this summer and meeting so many people from all different backgrounds with different life stories, I find myself appreciating medical school more. Yes, it’s still tough. Yes, there were 15 lectures (some great, and some not so much) in the first week. Yes, somehow I already seem to be behind. Yes, the boards are always looming in the back of everyone’s minds, but the task just doesn’t seem as daunting as it did last year.
Coming back refreshed, with biking as a new hobby (I think I’m addicted to endorphins and adrenaline) with a new adventure under my belt and new experiences to build upon, I feel ready to take on this upcoming year.
It’ll be interesting to see how things actually work out.
Till next time.