anna in med school

In my last post, I mentioned that I thought my conversation with the standardized patient went okay.  First of all, I have plenty of room for improvement.  However, for the times during which I asked pertinent open-ended questions, allowed for brief silences, restrained myself from interrupting, and displayed general conversational competence, I really have the Y’s & HMC to thank.  Over ten years of being a Ya-Ya, and a lifetime to go.  I’m still consistently non-threateningly socially awkward, but I’d like to think that I listen and communicate better because of my relationships with these good people.

I chatted with a good friend briefly last night and mentioned that we had had our first session with a standardized patient that day.  “What’s a standardized patient?”  Oh…right, I forgot that not everyone dates someone throughout his four years of medical school.  Anyway, I hope you all know how important accessibility is in this blog experiment, so please let me know if you would ever like me to clarify anything–I want to be able to share my med school experience with you!

A standardized (or simulated) patient is an actor trained to behave like a real patient, imitating symptoms and presenting an often detailed history.  At this point in the game, we’re at the basics, simply trying to have open discussions with the patients, getting them to open up to us about their chief complaint, medical and personal histories.

“Hello, my name is Anna and I’m a first-year medical student.  Would you mind if I speak with you for a few minutes before you see the doctor?  What brings you in today?”

Open-ended questions is the name of the game.

And all this exercise is done in front of our respective learning teams and preceptors, who can call time-out to give feedback.  After about 7-10 minutes, the scenario ends, and everyone (especially the patient) gives you feedback.

It sounds so basic, but it’s challenging (at least for me)…and totally invigorating!  I cannot wait to get in the hospital, to begin clerkships!  I think I did okay.  And, apparently, when I’m nervous, no one can tell that my hands are frigid or that my stomach is doing flips…which I take as a good thing.

If you’re a student either living in or visiting Philly, forget the tired dinner-and-a-movie date night.  Instead, check out one of the many FREE CONCERTS at the Kimmel Center, which is where I went tonight with a bunch of classmates to see the Philadelphia Orchestra and Joshua Bell.  There was even a reception held afterward in the lobby catered by Wolfgang Puck.  And Verizon Hall is shaped like the inside of a cello.

Don’t think you can make it until 10pm to enjoy free dinner?  With happy hour until 7pm and just two blocks away, Tria is a great option, especially in the middle of the week when the crowds are minimal and the service is super fast.  Order a $5 Happy Hour special of their house wine, the Mission Figs stuffed with Gorgonzola and Prosciutto di Parma, and the fennel spiced almonds.  Trust me.

John’s at a conference in Las Vegas (and otherwise living in Boston), so my dates were Jon and Jamie (another pair of old married farts like us), Doria, and Christina.  Somewhere in the middle of J. Bell’s delicious rendition of Mendelssohn’s Violin Concerto it occurred to me: I have friends here…actual friends.  I think Philadelphia is becoming my home.

Right now I’m taking a break from anatomy.  I am reading about the tétons de Venus instead of the mammary glands.  I am studying how to remove cartilage around the boned joint of beef rather than how to reflect back peritoneum.  All thanks to Caitlin and Chris, who just surprised me with the best care package ever, complete with Caitlin’s homemade brownies, gourmet olive oil, and this book.

It was waiting for me at my door when I returned from the library.  This week suddenly turned wonderful.

I’m trying to cram as much biochem into my head as possible right now.  I was just rewatching part of a lecture on gluconeogenesis, the metabolic pathway that results in the formation of glucose from lactate, glycerol, or amino acids.  Let’s take a step back for a sec: I mean, we’ve been talking about gluconeogenesis like it’s no big deal, but how amazing is it that our body is like, Whoops!  Out of glucose again.  We need some fuel to function, so let’s just make it ourselves.  WTF!  But, yeah, it’s a pretty common occurrence, so we talk about it like it’s no big deal.

Anyway, during the first few minutes of the lecture, our professor interrupted his regular spiel to tell us about how a student asked him, very politely (he specified), a few years ago why we even bother studying gluconeogenesis, since it’s a pathway we really rarely use…because when are we ever starving except during Yom Kippur.  Lllllll.  Well, I guess I’ve said my share of insensitive things.  Anyway, my professor took a few minutes to, again very politely and not at all patronizingly, explain that people in the world are starving.  One person dies every second as a result of hunger.  In 2007, there were roughly one billion hungry people in the world despite the fact that the world produces enough food to feed 12 billion people.  Behind heart disease and cancer, malnutrition is the third leading cause of death.  And, he concluded, as a scientist, this issue is one he grapples with a lot.  We devote so much time and energy to discovering new ways to treat and cure interesting but considerably less critical, on a global scale, diseases, while malnutrition is something that we can fix now.

Okay, I know all you out there with considerably more global health and public policy know-how are probably reeling because starvation around the world is certainly a complicated problem, and curing it is far from simple.  My point is not that it isn’t, and not at all to trivialize it as a topic of conversation by brushing it off for now (because I would enjoy getting into it further), but I love that I’m learning from scientists that both care deeply about the larger humanitarian concern and go so far as to question the very funding of their own research in light of it.

In other news, we cut out our cadaver’s heart today…he has a HUGE heart.  Seriously, I’m not really sure how he breathed.  His lungs were also significantly calcified.  It’s amazing to me how 2-3 hours in the anatomy lab can fly by in the blink of an eye.  The human body is incredible.

There’s a lot about Yo-Yo Ma to love.  For one, he freakin’ kicks ass at the cello and looks happy/friendly doing it.  He is, by all accounts, kind, generous, modest, and a pleasure to work with.  He contibutes a lot to modern “classical” music by making it accessible and culturally relevant.

And he says some pretty smart stuff too; I’m thinking of two instances in particular.  When I saw the Silk Road Ensemble perform (for free–thank you McIntire Dept. of Music!) at the Paramount in 2006, Mr. Ma earnestly called Harvard “the UVA of the North”–adorable.  But the words that I keep coming back to this weekend, which I’ve spent hopping between anatomy lab, libraries, and coffee shops (with a latenight jaunt at Doobie’s for a $4.75 gin martini), are some I think I heard during a BBC program a number of years ago.  Yo-Yo was relating his relationship with the cello to those of children everywhere trying to keep up with an instrument, despite the labors of practice.  One of the kids, I think, asked him if he liked practicing.  He said something to the effect of (this is not a direct quote): Well, it’s a funny thing.  I find that I really dread practicing.  And I put it off and put it off.  But then, once I’m doing it, it’s not so bad.  I kind of enjoy it.  And I love the result, that I can improve my ability through practice.  The tough part is getting started.

I feel similarly about studying.  I’ve been so frustrated with myself recently for not being productive, for not getting enough done, for being behind.  And I’ve really put off studying, partly because I know how long it takes me.  I’ve been discovering that I’m just going to have to be one of those med students who studies longer–this science stuff is not at all intuitive for me, and I really feel like I’m drowning in it.  But, as I was reading though lectures of physiology in the Fine Arts Library yesterday, I had this one moment of Hey, this might be hard as s— for me right now, but it’s interesting…this is how our body functions, how rad is that?! Once I get going it’s not so bad…now if I can just get to the point where I’m just a little faster and focused so I can sleep more, that would be swell!

And speaking of getting going, I should get back to it.  Oh!  And another thing I love about Yo-Yo Ma: how adorably he essentially “lip-synched” his performance at Obama’s inauguration.  Mr. Ma–frozen fingers, out-of-tune instrument, and all–way to tough it out for your country!

When it came time for John and I to have a “first dance,” your solo “Appalacian Waltz” was the only one that we could agree on.

So…I have been terrible about reading anything that’s not on a flashcard or in review notes recently.  Luckily, I have super smart friends who are both well-read and cultured…and they’re thoughtful enough to share articles that they think I would enjoy, which takes away all the risk of spending time reading something potentially boring or annoying.  I love my friends.

Anyway, below are three favorite articles that you should check out from the last several months:

Doctor’s Orders: Eat Well to Be Well

All Joy and No Fun: Why Parents Hate Parenting

What Broke My Father’s Heart

And some friends are writers in addition to their day jobs (I know, right?  My friends = not ambitious in the least).  Recent publications:

Lower Occoquan Watershed Plan Moves Forward

Where did our CT scan go to medical school?

And finally, I know I toss this article around a lot, but because I get to see Joshua Bell–only my classical musician crush!–perform FO’ FREE this Tuesday:

Pearls Before Breakfast (BTW, I was singing at St. Dominic’s just a few blocks away when all this was going down.)

Shocking no one recognized him…

On Monday, we had our first anatomy lab.  It seemed so…well…premature.  I mean, I’ve been in med school for a little over a month, I ordered my latex gloves, picked up a pair of scrubs, watched a short instructional video on how to attach and remove scalpel blades without cutting my fingers off,  and now I’m standing in front of a body about to make my first incision…and no one’s stopping me, or leaning over my shoulder giving me instructions.

And I’m shocked, and a little appalled, by how easy it feels, both physically and emotionally.  The blade pierces through the first layer or skin and fascia so effortlessly.  And I feel no discomfort.  I’m standing at the L1 position (the left side, upper truck area of the cadaver) and, as my hands become accustomed to the initially awkward position of the scalpel and the forceps, this first skinning process begins to feel natural…unnervingly so.

Our cadaver (he is not yet named) is a 78-year-old male.  He died on August 20, 2009 of coronary heart disease.  He is tall, relatively fit looking, with some fat about the mid-section, but nothing outstanding.  He has some synthetic material located in his lower-right side from a hernia repair.  We discovered another inguinal hernia that had yet to be repaired.

As I peal back the layers of pectoral and intercostal muscles, run my fingers across bones, blood vessels, glands, and nerves, I am learning so much from him, so much more than any lecture, book, or flashcard.  What a gift.  Thank you.

I still cannot help but feel like my aloofness toward this process is somewhat monstrous.  Why don’t I feel more?  At the end of day two in the lab, Nathalie and I chose to stay a few extra minutes in order to see his face.  I don’t know what I expected, but the unveiling revealed nothing extraordinary.  He has a gentle face and a buzzed haircut.  Still, I feel like I know him a little better now, I know who I’m cutting, and I can show my respect for a human, not just a body.

Back to day one, Monday: Kathleen was in town, and I had five wonderful hours with her in the evening.  She treated me to a luxurious pedicure, and then we took our freshly-pampered selves to yoga at the studio around the corner from my apartment.  After the half-marathon and anatomy, I appreciated even more this opportunity to treat my body well, and do so with one of my best girlfriends.  As we lay in final savasana following 90 minutes of vinyasa, my mind wondered back to anatomy lab…where my cadaver lay stiff in a very similar position.  If four medical students were to open up my midsection and begin the dissection process, what would they find?  What mysteries does my body hold?

Dear Readers,

It’s been too long!  I have not kept up my end of the deal: to write, albeit briefly, a little about my goings-on as a new medical student each day.  I’m not trying to be overly anal, but the act of writing really has been so therapeutic; it helps me appreciate recent experiences.  And you stopping by here, sharing your comments, and essentially keeping me honest (thanks so much for the inquiries about whether I’ve fallen off the face of the earth–I’m still here, at least in part), brings me joy.  Thank you.

This week…there is so much I would like to share, but most will have to wait until tomorrow’s mega-post.  Bottom line: I’m pretty wiped out.  And I need to figure out how to get all this shit done without driving myself totally batshit; my head is exploding.

Anyway, to hope that you stop by again tomorrow.  Topics of interest: meeting and getting to know my cadaver; elective class outside the med school–I don’t think you’re going to guess what I decided; the hash house harriers and my latest friend crush; how I told off a total douchebag.

For now, I’m falling asleep in my desk chair, so I think that’s my cue.  I look forward to reliving this week’s adventures tomorrow, and I hope that you have a fantastic evening!

anna

Rockin’ and Rollin’ the Philly Half this morning…

My nephew loves the color orange, so he got to wear the little piece of flare I got for finishing the race.