I know I kind of fell off the face of the planet in the past few weeks. Sorry about that. In the meantime, classes have gotten tougher, sleep has diminished, and we've had this little thing that we call Skit Night here at Einstein. I can almost guarantee that every med school has its own version of Skit Night, a night where students show funny videos, dances, songs, etc. that they've created to parody our lives as medical students. This year, I was featured in three short "commercials" between some of the longer skits. Here they are.
Saturday, February 19, 2011
Wednesday, February 2, 2011
Patient Interaction
The first time, I was nervous. I desperately hoped that my partner, whom I had happened not to have met during our entire first year and a half at medical school, would be excited and ready to do the physical exam, because I sure wasn’t – I was nervous. We found our patient. After introducing ourselves to her, I looked at my partner and suggested, somewhat proud of myself for thinking to do it this way, “Should I start with the history, then?” I would obtain the medical history, and then he would perform the physical exam. My plan was perfect.
Unfortunately, my plan was not perfect, and he was just as nervous as I was. “Well, I could do the history, and then maybe you could do the exam…?” He asked it as a question, but I already knew my plan had failed miserably.
Come on, Michelle, I thought. You’re in the Air Force. You can’t wimp out with something as small as this. You’ve just got to get through it; it will be fine. I didn’t want to be difficult, and I didn’t want leave my partner hanging on our very first day together. I acquiesced. It felt strange to be examining another human being who probably had no idea how little experience we’d had, but I had expected that. I was nervous, but I got through it.
The second time, I was less nervous. I was the one obtaining the medical history that time. I felt completely comfortable talking to my patient, finding out so many details about something so personal as her own body while also establishing a trustful relationship, an easy rapport. My partner and I talked through the exam, helping out one another. Of course it didn’t feel natural, but at least it didn’t feel as scary as the first time.
The third time, I was excited. By then, I was more familiar with the exam, more trusting of my partner, and more confident in my skills. An hour before, however, I learned that my partner was sick and would not be able to come that week. My certainty deflated instantly. Would I be required to do the entire history and exam on my own? I felt comfortable interacting with a patient alone, but I certainly did not feel ready to perform the physical exam alone.
The third time, then, I was incredibly nervous, but I was determined to do my best. To say it was easy would be an egregious misstatement. The patient was not at all talkative, answering most of my questions, even the open-ended ones, in single words or phrases. His accent and quiet voice made it even more difficult for me to understand and interact with him. When I had exhausted my mental stockpile of questions, I moved on to the exam with a new rush of nerves. He knew that I was a student, but at the same time, I did not wish to appear inept. I tried my hardest to appear as though I had done this sort of thing many times before. Since he was a chronic liver failure patient, he had seen his share of medical students. As I performed the exam, he told me about a time he did not feel comfortable with the student. It did not seem to him that the student knew the right exam procedures. I paused. Was he hinting that he didn’t trust me? I looked him in the eyes. He went on, “But you – you’re all right.” Not wanting to violate his trust, I asked his permission before I proceeded with the rest of the exam, to which he replied, “Of course.”
I’ve only participated in the physical examination of three patients, but I’ve learned so much already. I’ve realized that it is natural and even expected to be nervous for these powerful new experiences. I’ve also realized that as nervous as I may become, I can do it. I can establish relationships with patients, and I can work through my own apprehensions to learn the most important skills we’ve been taught in medical school thus far. Some exams will be more difficult than others, but that’s why I chose medicine. I wanted to interact with people – people whose disease processes, medical histories, temperaments, and ultimately lives are all different. I’ve been nervous, but I’ve also been privileged. I can’t wait to continue to experience the miracle of interaction throughout the rest of my career.
Monday, January 24, 2011
Simple Joys
I was extremely happy a few days ago. Extremely. I found...
Starfruit!
Also known as carambola.
And I ate it.
Wednesday, January 19, 2011
Feet
First admitted patient.
We talked about her asthma, listened to her wheezing lungs. They were musical, singing a chord every breath she took. She told us that she had diabetes as well. Wishing to be thorough - and hoping to practice as much of the physical exam as we could in our allotted time with her - we attempted the neurological exam. Attempted, because we didn't have all the necessary instruments. We did, however, have a tuning fork. Proprioception was fine in her fingers, but what about her toes? I moved to the foot of the bed, asking her if I could remove her hospital-issued socks. Underneath, her feet were dry and cracked. Her toenails were fragile. Proprioception was not fine; she couldn't feel the fine vibrations of the tuning fork. She didn't seem concerned. She'd probably never had a tuning fork pressed to her toes before. I helped her put her socks back on and thanked her for helping us learn.
First ER patient.
She came to the hospital, on the busiest day of the year, because of the pain in her ankle. She and her home-health aide braved the crowded department with the beds triple-stacked and protruding into the already crowded walkways, because she herself could not walk with the pain. We touched and maneuvered her ankle. "Ohh!" she cried in pain. We moved her knee. "Ohh!" We manipulated her hip. "Ohh!" again. What was the problem? The ankle, the knee, the hip? Which one had caused the others' pain? But her feet were fine. I tried to find her dorsalis pedis pulse, assuming it would take several tries since I can never seem to find it even on my own feet. First try, and there it was, bounding and strong. Her warm feet were more lively, it seemed, than my own.
Second ER patient
She was in the West section, the one where those with the most serious problems are taken. My preceptor, wanting to make sure I saw interesting cases in my afternoon at the ER, asked another of the attendings if she had anything cool. "I've got a woman with a cold foot." We found her and said hello, but she was only minimally conscious and did not even acknowledge us. Still, a good teaching moment. We felt her right foot; it was, indeed, cold. And her ankle. And her calf - but not her knee. Left side was not what I would call warm, but it wasn't as cold as the right. Left was pink; right was white. No pulses on the right leg, but the femoral pulse was strong. Was it a DVT? Something else? Doppler had been scheduled, but they were unsure if they would admit her or not; they might just send her back to the nursing home. Before we walked away, I looked again at her feet. Most of the digits were hammertoes. I tried to imagine her as a young woman, wearing nothing but high heels every day. In my mind, she was happy, beautiful, fashionable, not minimally conscious in an ER bed with a cold foot. I walked away and wondered what would happen to her.
Second admitted patient
What didn't she have? We talked about her asthma, her quadruple bypass, her liver cirrhosis, her kidney failure, her ascites, her edema, her shortness of breath. Despite all of these problems, she looked at least twenty years younger than her real age, even though she had already told us about her six great-grandchildren. She had a moment of sadness when telling us of her frequent hospitalizations, and of how scared she felt when she suddenly couldn't breathe, or when her nose suddenly spilled clots of blood. I tried to comfort her despite having only minimal experience in this sort of thing. She cheered up, then commented about how hard it was getting old. I laughed, and she smiled. "She's laughin' at me, but it's true! It's hard gettin' old!" she laughed back. We began the exam, hearing her labored breathing and the shifting dullness of the abdomen. She told us she had diabetes, so out came the old tuning fork again. Off came the socks again. She looked down and commented on her feet. "I got no one to take care of my feet. Can't cut my nails." It was too hard for her to bend down that far to do it. "I look at them, and they look like claws to me!" she pronounced with a grin. I smiled back. I never knew you could learn so much from feet.
We talked about her asthma, listened to her wheezing lungs. They were musical, singing a chord every breath she took. She told us that she had diabetes as well. Wishing to be thorough - and hoping to practice as much of the physical exam as we could in our allotted time with her - we attempted the neurological exam. Attempted, because we didn't have all the necessary instruments. We did, however, have a tuning fork. Proprioception was fine in her fingers, but what about her toes? I moved to the foot of the bed, asking her if I could remove her hospital-issued socks. Underneath, her feet were dry and cracked. Her toenails were fragile. Proprioception was not fine; she couldn't feel the fine vibrations of the tuning fork. She didn't seem concerned. She'd probably never had a tuning fork pressed to her toes before. I helped her put her socks back on and thanked her for helping us learn.
First ER patient.
She came to the hospital, on the busiest day of the year, because of the pain in her ankle. She and her home-health aide braved the crowded department with the beds triple-stacked and protruding into the already crowded walkways, because she herself could not walk with the pain. We touched and maneuvered her ankle. "Ohh!" she cried in pain. We moved her knee. "Ohh!" We manipulated her hip. "Ohh!" again. What was the problem? The ankle, the knee, the hip? Which one had caused the others' pain? But her feet were fine. I tried to find her dorsalis pedis pulse, assuming it would take several tries since I can never seem to find it even on my own feet. First try, and there it was, bounding and strong. Her warm feet were more lively, it seemed, than my own.
Second ER patient
She was in the West section, the one where those with the most serious problems are taken. My preceptor, wanting to make sure I saw interesting cases in my afternoon at the ER, asked another of the attendings if she had anything cool. "I've got a woman with a cold foot." We found her and said hello, but she was only minimally conscious and did not even acknowledge us. Still, a good teaching moment. We felt her right foot; it was, indeed, cold. And her ankle. And her calf - but not her knee. Left side was not what I would call warm, but it wasn't as cold as the right. Left was pink; right was white. No pulses on the right leg, but the femoral pulse was strong. Was it a DVT? Something else? Doppler had been scheduled, but they were unsure if they would admit her or not; they might just send her back to the nursing home. Before we walked away, I looked again at her feet. Most of the digits were hammertoes. I tried to imagine her as a young woman, wearing nothing but high heels every day. In my mind, she was happy, beautiful, fashionable, not minimally conscious in an ER bed with a cold foot. I walked away and wondered what would happen to her.
Second admitted patient
What didn't she have? We talked about her asthma, her quadruple bypass, her liver cirrhosis, her kidney failure, her ascites, her edema, her shortness of breath. Despite all of these problems, she looked at least twenty years younger than her real age, even though she had already told us about her six great-grandchildren. She had a moment of sadness when telling us of her frequent hospitalizations, and of how scared she felt when she suddenly couldn't breathe, or when her nose suddenly spilled clots of blood. I tried to comfort her despite having only minimal experience in this sort of thing. She cheered up, then commented about how hard it was getting old. I laughed, and she smiled. "She's laughin' at me, but it's true! It's hard gettin' old!" she laughed back. We began the exam, hearing her labored breathing and the shifting dullness of the abdomen. She told us she had diabetes, so out came the old tuning fork again. Off came the socks again. She looked down and commented on her feet. "I got no one to take care of my feet. Can't cut my nails." It was too hard for her to bend down that far to do it. "I look at them, and they look like claws to me!" she pronounced with a grin. I smiled back. I never knew you could learn so much from feet.
Monday, January 10, 2011
Victory a Long Time Coming
Beginning over two months ago, a few of my classmates began campaigning for a drastic change to our academic calendar. Without going into excruciating detail, let me explain briefly.
At Einstein, our spring break is always - always - centered around Passover (since Yeshiva's a Jewish school, many of our students are orthodox Jews, etc., etc.). This spring, Passover is exceptionally late (coinciding, as it almost always does, with Easter). That puts us second-years in an awkward position, since we come back from spring break for literally two days of class and two tests, and then immediately begin studying for the boards. Awkward because it means we only have five weeks for boards study (whereas most other schools have six or more). Awkward because it means students who would like to go home for the holiday and for boards study will have to (potentially) fly twice in a very short time ($$$). Awkward because it would necessitate studying for classes - or the boards - or both - during what is supposed to be a break.
Two months, two surveys, multiple meetings, and a gazillion e-mails later, we got what we wanted. The deans, the executive committee, and the course leaders will allow the schedule change now that we have shown that over 95% of our class is in agreement with the proposed changes. (Sidenote: It's next to impossible to get 95% of medical students to agree on anything, so you can imagine how big of a deal many people thought this was.) Now all of our classes finish on April 15. We don't begin third year until June 13. There's plenty of time now - over eight weeks - to study for boards. How do I plan to spend those three extra weeks?
Vacation. Probably.
At Einstein, our spring break is always - always - centered around Passover (since Yeshiva's a Jewish school, many of our students are orthodox Jews, etc., etc.). This spring, Passover is exceptionally late (coinciding, as it almost always does, with Easter). That puts us second-years in an awkward position, since we come back from spring break for literally two days of class and two tests, and then immediately begin studying for the boards. Awkward because it means we only have five weeks for boards study (whereas most other schools have six or more). Awkward because it means students who would like to go home for the holiday and for boards study will have to (potentially) fly twice in a very short time ($$$). Awkward because it would necessitate studying for classes - or the boards - or both - during what is supposed to be a break.
Two months, two surveys, multiple meetings, and a gazillion e-mails later, we got what we wanted. The deans, the executive committee, and the course leaders will allow the schedule change now that we have shown that over 95% of our class is in agreement with the proposed changes. (Sidenote: It's next to impossible to get 95% of medical students to agree on anything, so you can imagine how big of a deal many people thought this was.) Now all of our classes finish on April 15. We don't begin third year until June 13. There's plenty of time now - over eight weeks - to study for boards. How do I plan to spend those three extra weeks?
Vacation. Probably.
Wednesday, January 5, 2011
Hats Are Made for Your Head
...for when it is cold outside, to keep you warm instead! We sang that song in elementary school - fifth grade, maybe? I can't remember the rest of the lyrics. Why is it relevant?
For this year's new year celebration, seven of us rented a house in Whalan, MN, for two nights. (As an aside, we increased the town's population by approximately 12% for those two nights.) The Cyclin-Inn was very homey and had everything we needed, as well as some things that we didn't necessarily need, but ended up loving:
For this year's new year celebration, seven of us rented a house in Whalan, MN, for two nights. (As an aside, we increased the town's population by approximately 12% for those two nights.) The Cyclin-Inn was very homey and had everything we needed, as well as some things that we didn't necessarily need, but ended up loving:
Hats.
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