February 23, 2008

Charlotte's Web

They say if you want to go into surgery you have to love the OR. I've always said yeah... that makes sense. You don't become a professional baseball player if you're allergic to grass.

Which brings me to one of the most disconcerting experiences of my life. From a very young age, I was fascinated by surgery. I watched operations on the Discovery Health Channel, the UW Medical Channel (which conveniently got pumped through the cable into my dorm room in college!). I've always envisioned myself as a surgeon. Told people I wanted to be a surgeon. People always told me I looked and acted like a surgeon. Hell even my Meyers-Briggs test matched me as a best fit into... surgery. Which brings me to my first OR experience in medical school.

After the initial thrill and the incredible sight of the surgeons disassembling someone's body (dramatic embellishment) and the OH MY GOD I'M IN SURGERY! ... I was bored. I'm almost ashamed to type it, but I was. My legs ached from standing, my goggles kept fogging up, and I couldn't follow what was going on. It was horrible.

The good news: things got better. The surgeons let me do a couple menial things a few times, which helped keep my attention better. But it still felt boring. And it scared me, because I almost felt like my visions of my future self were slipping away, and needless to say that was a bit frightening.

At the beginning of our Systems Processes and Homeostasis block, we got to sign up for a variety of labs which helped reinforce a variety of the concepts we were taught in class. One of the labs was a controversial lab where we worked with anesthetized live pigs, learned how to put in central lines, and observed various effects of the cardiovascular system with some manipulation.

I signed up for it, mainly because it sounded like a cool experience. I arrived in the lab this week and found our team's pig on the table, quietly unconscious and on a ventilator. Our team divvied up tasks and the task of cutting into and exposing the internal jugular vein in order to insert the central venous line landed on me (with a little bit of coaxing by myself).

Now, I've been through 12 weeks of anatomy and dissected and studied the entire human body (which was equally thrilling and boring). Any medical student can attest to the fact that working on a cadaver is both an exciting and frustrating experience. Things adhere to each other, vessels and nerves snap if you don't meticulously search them out beforehand.

With that in mind, I made my very first incision into live tissue. Unlike preserved tissue, the scalpel glided through the dermis as smooth as silk. The capillary beds bled then closed off as the body's clotting mechanisms kicked in. I found the fascial layer beneath the dermis and slowly dissected to open the incision. Unlike in a human, where the jugular is conveniently located in the easily exposed neck, in a pig it is buried down beneath layers of muscle and connective tissue. I delve deeper, finding an experience completely contrary to that of anatomy.

And it all clicked. I saw the thyroid gland, sitting with its glistening arteries wrapping themselves around the enclosed clusters of thyroglobulin. I saw the recurrent laryngeal nerve looping back up supply CNS control. I found the carotid, briskly pulsing with the powerful pressures of the heart. The vagus running down along as its mate to its destination on the heart. And I found the jugular, slowly pulling it out of its enclosing carotid sheath.

I finally understand and appreciate surgery. The elegance of it, the concentration needed during it. The care and the meticulous nature of it. I can understand why it can seem boring if you're not locked into the moment of it, but when you're involved in it, when you're focused so intensely on what you're doing, focused so intensely on what you're planning next, its like being in 'the zone.' If I end up in surgery (and I'm keeping an open mind throughout medical school) I think this will be the experience that I can look back and point to that sold me on it. Which is funny. Because if that's the case, I didn't decide on surgery because of some dramatic and amazing experience in the OR with a human. It will have been because of a pig.

Jesus, my future professional career can theoretically now be traced all the way back to Babe. But you know what, I think I'm cool with that. Word pig, ya did good.

BTW... Props to the 480, Arizona. The land of desert, desert, concrete, and more desert. If I was a rattlesnake, or dating a professional ice skater, I'd live there.

Past Self, Meet Self.

It's amazing how thing's in life come full circle. While in college, I was a 'child life' volunteer during the summer at Doernbecher Children's Hospital in Portland. We really didn't do much of anything clinical, but it was a great opportunity to get to know and connect with a great number of brave and incredible children (and families). I operated mainly on the 9th floor acute card ward, but would occasionally float up to the 10th floor cancer ward. Needless to say, the kids I met up on the 10th floor provided me with some of the most inspirational encounters of my life, and ultimately shaped my decision that no matter what area of medicine I went into, I wanted to subspecialize into pediatrics (screw the lower reimbursement!).

Well, I'm back. For the next 13 weeks, my clinical preceptorship will be on Doernbecher's 10th floor following and learning from a pediatric hematologist/oncologist. Nearly 3 years ago, I roamed the halls with a bright blue volunteer polo with a big red wagon in tow. Now I'll be roaming those very same halls with my white coat in tow. Besides the obvious opportunity for my own personal reflection on how far I've come in those past 3 years (and even past 6 months), it gives me a great opporunity to integrate those incredible experiences which made me want to be a physician in the first place into my current medical education and growth.

Cancer is tough. When kids get cancer its really heartbreaking, on an indeterminable number of levels. But the kids in pediatric oncology also showed me one of the greatest aspects of working with children in medicine: kids fight. They fight so damn hard. It's what makes pediatric oncology one of those most interesting areas of medicine in my eyes. The failures are that much more gut-wrenching. But the success is even more rewarding.

I think this is a great way for me to round off my preceptorship experience for the year. I got to work with an orthopaedic trauma surgeon... and learned that really wasn't for me. I got to work with a cardiology specializing in congenital heart disease... and learned that right now my passion still lies along those lines. And I get to work with a pediatric oncologist... which means I finally start to get to see and work with kids again.

That's my update for now. We just finished a particularly brutal stretch of the curriculum, 3 exams and 2 quizzes in 4 weeks. One more exam next week and I'm back to normalcy. And on that note, I'm out.

February 17, 2008

So easy a monkey could do it.

As a first year medical student, they don't trust you to do a whole lot around the clinic or on the wards (and frankly, I don't blame them). So we make do by finding excitement in the little things. "Dude, you got to TAKE OUR SUTURES today? Awesome!" "I can't believe they let you disempact the patient's bowel!" "Whoa, they actually let you CUT the tendon?! NO WAY!" This week, I got thrown a bone of my own.

I got to push a button.

Now, I know what you're saying. But this wasn't just any button. This button was hooked up to a machine. A defibrillator more specifically. And pushing that button delivered 250 joules of energy through a man's chest, lifting him several feet off the bed and returning his heart from abnormal atrial flutter to boring sinus rhythm. Ah, cardioversion.

It went down like this. It was my last week in cardiology clinic and we had a whole two patients to fill the next four hours of time. So my preceptor, bless his soul, decided to send me up on the hill to follow a patient from earlier who was being admitted to observe his cardioversion. Y'know, last week in cardiology, might as well see the cool stuff. So I find the appropriate room, give the fellow the rundown, and we go in and meet the patient. Really nice guy, with a great attitude and sense of humor. And as I introduce myself, I say "Hi, my name is MedZag, I'm a medical student who is going to be observing your cardioversion. Don't worry, they won't let me push any buttons or anything. Ha. Ha. Ha." Wow, either I'm a horrible psychic or have an incredible sense for irony. We get the pads all hooked up, get him sedated, and page the attending. The attending arrives (*dramatic music*), checks all the numbers, and gets ready to give the go ahead. Just as the moment arrives, he turns to me, standing in the corner (oh my god! he noticed me!), and says the words that made my week:

"You want to do it?"

Now the appropriate response would have been something along the lines of "Yes, sir, I would appreciate the opportunity to further expand my medical experience." Instead, all I was able to mutter was a highly confident and assured... "Sure." So the attending shows me how to set the appropriate knobs and dohickeys on the defib (yes, $40,000 a year towards my education and I still use the word 'dohickey'), shows me the charge button and the big red discharge button, and makes very damn well that I "hold down the button" when I press it. Then the time comes. The countdown... 3... 2... 1... and BAM! I press that button better than any first year medical student has ever pressed a button, held it down TWICE as long as needed to prove that I'm a good listener, and watched as the patient's back arches and his body rises two feet off the bed. The EKG goes crazy then slowly settles down and... normal sinus rhythm. Damn, he's good.

The attending says "good job," I reply with an equally confident "thank you," while my brain is screaming "OH MY GOD! That was freaking AWESOME! OH MY GOD! WOW! JUST WOW! OH MY GOD!"

It's the little victories that get me through the day. Soon enough, I'll yawn at such experiences as I move on to bigger and grander things in my medical career. But I'm really just trying to enjoy the journey along the way (said after a long weekend slaving over autonomic physiology and pharmacology which has subsequently leeched all the joy out of this week). And damn, it's never been so much fun to push a button before.

BTW... 1000 visitors. CHEYYYAAAAA!!!! Visitors from Libya, Nigeria, Pakistan, and the Netherlands. New Hampshire, Minnesota, Tennessee, and Nevada. Very cool stuff.

February 6, 2008

Drugs For Me

We've reached the pharmacology segment of our education.

They say we will know 100-200 drugs by June. 500 drugs by the ends of second year. And over 1000 by the time we graduate. Right now I know... 12 (and three of those are aspirin, ibuprofen, and acetaminophen - I know, I'm so smart).

There's a lot of hate directed at the pharmaceutical companies in this nation these days, with their high prices and shady marketing tactics. I've started to hate the pharmaceuticals too, but for an entirely different reason: they have to come up with their own damn propriety name for every drug they make.

Say you're riding on the light rail and overhear a guy talking about how he had a bad experience with his sildenafil and had to go to the emergency room cause of... complications and the misses was hysterically crying the entire time in the waiting room. You would probably shrug off his comments, feel a little bad, go back to reading your New Yorker (you trendy ass), and queue up the next indie track on your iPod.

Now what if I say you're riding on the light rail and overhear a guy talking about how he had a bad experience with his Viagra™ and had to go to the emergency room cause of... complications and the misses was hysterically crying the entire time in the waiting room. Well then you'd probably laugh, dial up your college buddy on your phone, tell him the story then when he picks up then blast The Starland Vocal Band's "Afternoon Delight" from your iPod headphones loud enough the dude might hear it.

And its all Pfizer's fault that you might have missed a perfectly good joke in scenario #1 because they marketed their pill as "Viagra" (what the hell is that supposed to mean anyways?) instead of it's drug name: sildenafil.

Ibuprofen? or Advil?
Carvedilol? or Coreg?
Simvastatin? or Zocor?

Hell, the brand names don't even make sense. Celebrex? Sounds like a weird sex fetish, not a COX II inhibitor. Zoloft? Sounds like a planet in a galaxy somewhere, not a SSRI. Lipitor? Sounds like a name of an evil alien warlord out of Scientology (zing!)

But mainly I'm just pissed because it doubles the number of drug names I have to memorize.

Of course, it'll be worth it. We're finally reaching the part of our education where our lectures are for the most part directly related to the clinical aspect of medicine. Which is cool. Cause I kinda got into this doctor thing for the whole "helping patients" part and not the whole "memorizing 500 different enzymes" part. And its always fun when you start a new subject in medical school. It brings back a little bit of that "WOW! COOL! MED SCHOOL!" in me that was running out of my nose back in August.

So, for now...


P.S. A big props to the people who have left comments recently. I love comments. They remind me people actually read this thing and I am not talking to myself all alone out in cyberspace. Way to go readers!

P.P.S. Just learned today that the propriety name for Benzocaine is HURRICANE®! Now that's what I'm talking about UltraMed! A name which inspires fear and confidence in your product!