Friday, September 30, 2011

My first love has lost a bit of its luster

Last week, I watched a live donor liver transplant.

Well, I watched 6 hours of it anyways. They had just transferred the liver when I left.

Woah, talk about invasive surgery.

I got to hold a gall bladder. When I squeezed it, all the bile came out. I was not able to hold the transfer liver. But I could poke the cirrhosis-ed liver.  I saw my first portal vein, first stomach, first spleen, first intestines and first hernia. All of that was super neat.

You know how you keep a patient alive while they don't have a liver? You hook them up to this machine that acts like their liver, cleans all their blood outside of their body and then returns it through a vein back to the body.

And the surgeons! Incredibly smart, talented and focused. All 7 of them.

But, and you knew there was a but. Since when did it become cool to completely neglect your basic needs as a physician, in favor of 8 or 9 hour surgeries? Maybe it has always been cool, and this was the first time I saw it in action?

We went into the surgery at 9, and by 2:30, I was REALLY hungry. And the scrub nurse and circulating nurse laughed and said, "You'll get used to not eating.", I don't think I will. See, I need food TO LIVE. It's especially bad when you consider that I lift weights regularly, so my metabolism is a bit amped up. I get fairly uncoordinated without food. By 2pm, I had a raging headache from not drinking any water for 6 hours, and I'm pretty certain I would have given up with those fine veins and arteries left over in the donor abdominal cavity. Props to the surgeons that completed that surgery and stitched the patient up.

OMG, food, nom nom nom
Also, I don't know about the other women around here, but I need to pee at least once every 8 hours. And, shhh, I don't think that's too crazy to ask.

So maybe I'm not cut out to be a long-surgery type person. I mean, as the patient, I wouldn't want my surgeon to leave and eat some lunch while I'm lying open on the table. Well, unless they are a diabetic or something. What do diabetic surgeons do? Maybe they just don't exist.

There are still short surgeries. And maybe that is better anyways. I'm not a fan of getting a call at 3am in the morning that a liver has become available. On my way to an 8 hour surgery with no food or water, woot!

I guess I'm not hard core enough to be a crazy cool surgeon like the ones I observed.

But that's alright. There are lots of other fish in the sea. Maybe I am more cut out for medicine. Third year is going to be really interesting.

Anyways, I have plenty of time, so I'm not worried. I'm just surprised that the live donor liver transplant and what has to be one of the coolest surgeries in the world turned me off from surgery a bit.

Protip: Introduce yourself to the circulating nurse whenever you enter an OR for the first time. They really liked that.

Monday, September 26, 2011

Fallen off the face of the earth?

No! I haven't, I promise. I'm working on writing some posts for this week. Never fear. I will be posting soon enough. In place of a post, here is a picture of dogs surfing.

You heard me.

Wednesday, September 21, 2011

Got my camouflage today

Here, have a stock photo of some white coat ceremony

I got my white coat today. I now blend in with the medical crowd.

It feels...weird.

The ceremony was uneventful. And long. 200 students putting on jackets takes a lot longer than you might think.

And yet, I was inexplicably excited the entire time. And I'm excited now that I have my jacket. I can't wait to wear it this week for the first time. Like I'm a legitimate medical student now. As if my tuition disappearing into the coffers of my medical school wasn't enough.

But no, the white coat gives me something a little more solid.

As our keynote speaker said, "Your white coat should feel heavy." We assume quite a mantle of responsibility with it.

I have to reproduce our keynote's speech here for you, because it was excellent. By far one of the better commencement-ey type speeches I have heard.

At times like this, I curse my anonymity a bit. She deserves to have her name known with this speech.

She spoke about attention. About a painting of Icarus falling into the sea, but no one in the painting notices. She urged us to take the time to notice our patients. She insisted that our training would try to stamp that urge out of us: attendings will be in a rush, we'll be tired and run-down from long hours and little sleep. She warned that we multi-task so much right now - doctors have the urge to bring this into the patient room. She said, "Don't. No matter what you think, you cannot pay attention, real attention, to someone when you are doing something else."

She quoted Robert Carver from "What the Doctor Said" delivering news of metastatic lung cancer:
...he said I'm real sorry he said
I wish I had some other kind of news to give you
I said Amen and he said something else I didn't catch
And not knowing what else to do
And not wanting him to have to repeat it
And me to have to full digest it
I just looked at him for a minute
And he looked back...
The doctor returned his gaze. How powerful that can be.

She spoke about curiosity. About a physician asking an old frail woman about her medical history, even though everyone in the hospital thought she was a pain and disinteresting. About the physician discovering this little old woman had been on the Titantic.

Our speaker segued into everyone being a survivor of something. Whether it was cancer, kidney failure, diabetes, a shoulder injury, loss of a loved one, emotional abuse, the list goes on. Everyone has something to tell. And as doctors, we can learn something from every patient.

And finally, she shared with us her own struggles. How her two oldest sons were born severely brain damaged. How her middle son died unexpectedly when he was four years old. How her and her husband just had another child several months ago.

She's been on the other side of the table from the physicians. And those who failed in their compassion did nothing to help her, or her sons. In her opinion, our greatest tool as a physician is our compassion. And you cannot care for someone without it.

She urged us: "Trust me on this. I know."

She got a standing ovation until she cried.

Monday, September 19, 2011

Best trade ever

Check out my new bling at the top!

I even have a new favicon logo!

Courtesy of Tyler Louie. Unfortunately, you'd probably have to be friends with his fiance to get him to design a logo for you.

And you may or may not have made a deal to channel all his fiance's girly wedding talk to you, instead of him. Because he was listening to her indecision about earrings for hours on end. And let's be honest, Tyler doesn't care about earrings.

But I do need some type of catch phrase. I've been unsuccessfully trying to think of one. Anyone have any ideas? I'll give you a cookie if you come up with one.

"Medical school. Family. Life." was what I was using before. Did you all like that?

I was also thinking of "An overshare of medical school life" or "Space Fighter Pilot. Doctor. Close enough."

Please give me ideas for tag lines. I'd be so grateful. My brain just refuses to work most of the time anymore unless I am thinking about glycolysis, TCA, birth defects or histology slides.

Sunday, September 18, 2011

It's not called the Mercedes scar anymore; it's a Lexus

SMBC comics are awesome

So last week was my first time shadowing a transplant surgeon.

One of the first things she told me was that liver transplant scars used to look like this:

See the Mercedes?
But now, they don't make the third incision to the side, so the scar is just called the Lexus.

 It was completely different to be shadowing a doctor as a medical student instead of a premedical student. Suddenly, I was almost like part of the team. I shadowed the doctor during clinic, and she briefed me on every patient before we saw them. She explained the difference between fibrosis and cirrhosis, how liver tumors are treated, what influence Hepatitis C has on the liver - everything! I got to see labs and radiology reports (even though I had no idea what I was looking at). I did recognize a liver tumor on a CT scan though - before the doctor told me what it was. I win! Alright, I admit, it was pretty obvious.

 I saw a bunch of things I'd never seen before. I saw some jaundice, with significant yellowing of the whites of the eyes, and spots. I can't remember what they are called now, but there are some spots that occur with liver failure.

 I saw pitting edema for the first time ever. That's so neat! Not so neat for the patient, but I'd admit to being SUPER excited ABOUT EVERYTHING. Pitting edema is swelling that when you depress the skin, the skin doesn't bounce back like normal. Instead, a depression forms in the skin.

 The surgeon was incredibly candid with me. She told me that she'd much rather be in the operating room, but clinic was a fact of life.

 Watching her interview, I thought I was watching something out of "doctor blunders" in our interviewing class. Everything we've been told repeatedly not to do, was done by this doctor. She would click her pen throughout the patient talking. She typed into EMR the entire time the patient was talking, and rarely looked at them. She didn't ask for permission to touch the patient, etc, etc.

 But for all her "flaws" interviewing, her patients really seemed to like her. She had a way of paying very close attention to the patient when she wasn't on the computer. And she always made sure she was at the same level as the patient. If they were laying on the table, she was standing next to them. If they were sitting in a chair, she was sitting in a chair.

 In the middle of one appointment, a husband and wife started fighting. The husband began screaming at the wife, and the doctor just calmly talked over him until he paid her attention. I certainly learned a lot.

 But the most exciting part is yet to come. Wait for it, wait for it.....

 You probably didn't guess it. This week I get to watch a live donor liver transplant. You heard me. I have to miss class for it. Psh, whatever, I'm there. Color me excited.

Monday, September 12, 2011

The first exam is the hardest part?

I took my first medical school exam today. It was actually a very non-stressful day. I woke up at 7:30am (sleeping in for the win!), had a nice commute in (40 minutes), took the exam, and got out of class for the day at 11:30am!

Woah! An entire day without work and without being behind? What will I do with this gift?

Have a party? (Wait for it...kudos to you if you get it)
(Those who don't get this picture, don't go looking it up) (Credit to Zeke)

Drink heavily?
Jump up and down? Probably not, my knees hurt.

Instead, here is how my day actually shaped up:

Now, I suppose it's a little unfair to say the test was not stressful. Here is an example of one of our practice exam questions:

 1.   A six year old girl is brought in for evaluation of short stature. She is of normal intelligence, but upon further work-up is found to have a coarctation of the aorta, a single kidney, short fourth metacarpals and widely spaced nipples. Karyotype is most likely to show:

a.      47,XX,+21
b.     47,XXX
c.      46,XX
d.     46,X,del(Xp)
e.      45,XX,der(13,14)(q10;10)

Here is an example of a question from our exam today:

Pedigree from here
If C10 carries the Cystic Fibrosis gene, and A14 is a rainbow unicorn, what is the probability N4 will buy a red car? 

Alright, maybe I exaggerate. But not by much.

I hope this isn't a pattern.

PS. As an aside, we are the first med school class that does not have to *purchase* practice exams. You heard me correctly. Previous classes had to pay $40 for practice exams last year (which went to charity). As if my tuition isn't enough. We calculated it out, and our entire class is paying $17,000 per lecture. But no practice exams for med students. I can just imagine last year: "Oh man, should I pass my exam or eat this week? Decisions, decisions." Is it just me, or should our school be forced to attend our ethics class?

Sunday, September 11, 2011

Good riddance, last week

Last week was an emotional week.

We had a patient presentation about HIV/AIDS. During the presentation, our professor told us that most people who had AIDS in the 1980s had died. The patient who spoke with us had had AIDS for 20 years! 

He started the talk by asking if anyone would give him a hug. It took a minute, and then someone got up. He laughed and said, "Thanks, it's not necessary. I just wanted to show you all that the stigma of AIDS isn't quite gone."

He spoke candidly about being diagnosed, sharing the news with his family, and how it had affected him. It brought back a lot of memories for me. 

My biological dad was diagnosed with AIDS in 1985. 26 years ago. I'd imagine he's one of the oldest surviving AIDS patients in the world.

As if hearing about living with the disease wasn't hard enough, the patient looked JUST like my dad, right down to his mannerisms and style of speaking. 

I think it was so important for our class to understand the gravity of having a disease like AIDS and how it changes your entire life. But at the same time, I'd already been through it, and let me tell you: it wasn't fun.

At this peak, my dad took 74 pills a day. 


Yeah, he used something like this, but it was for ONE DAY. He had to take medication every four hours, whether he was sleeping or not. 

I remember going to school with him in the morning. Snow would be streaming in our car windows from outside. I'd be in my jacket, wrapped up in a blanket and still be shivering. My biological father would be wearing shorts and a T-shirt. And he'd be sweating.

I remember being in Disney world, and my biological dad was wheeling around an IV with him. 

The side effects are not done justice by any description I have ever heard. My biological dad became emaciated. He had uncontrollable nausea, diarrhea, sometimes both at the same time. He was always tired and sick. Sores opened on his body and never closed. He's had a heart attack, and is suffering from congestive heart failure. He would waste, losing weight incredibly quickly. Then, he would gain it all back in his abdomen area. His limbs suffered weird muscular problems that he couldn't get to go away. He was in and out of the hospital at least 5 or 6 times a year. 

But you can't be scared all the time. I mean, after the fifth hospitalization, you just become desensitized to it.

The bottom line is: he lived. Against all odds he lived. I came to terms with his (what I thought would be) imminent death a long time ago. So now, thinking of his battle with AIDS isn't as painful as remembering our estrangement when I was 16. 

But after thinking about all of this for much of the week, I also found out that a family member may be fighting against a serious disease. Let's hope they aren't.

And then, to pour salt on my wounds, I got trapped in an elevator for 45 minutes on Friday! With 12 other people all crammed against me. I could barely move. After I told them not to get on the elevator because it was too many people. Dag nab it, life.

I'm sure next week will be better. Although I do have an exam tomorrow...

Monday, September 5, 2011

Oh humanity, how are you still successfully propagating?

So my husband and I are thinking about when would be a not-totally-suicidal time to have children during medical school and residency.

Well, at least we were. Until I started taking Genetics.

Oh dear god, what is that? A child, you say? I don't believe you. Holy cow, soooooooo much can go wrong. Can't unsee; can't unsee!

Last week, we spent almost every day looking at dead, dying, or several deformed pictures of fetuses or small children. Awesome.

Our genetics professor:

"Trisomy 18 is characterized by mottled skin, small stature, rocker bottom feet, congential heart disease and small mouth. 95% of these children die within the first year. But hey, it's better than Trisomy 13 which is characterized by facial clefts, abnormal spinal and head defects, extra fingers/toes and cardiac anomalies. Most of these babies don't even make it out of the womb! 95% of Trisomy 13 babies die within 6 months instead of a year."

Wow, genetics prof, that IS a relief to be diagnosed with Trisomy 18 over 13. I'll be sure and let the parents of a Trisomy 18 child know that.

If I see one more picture of a cleft lip or a progeria patient, I'm going to make my husband get a vasectomy.

I purposely did not put links to Trisomy 18, 13 or cleft lips and left this post devoid of inline pictures. You can Google those yourself if you are determined to feel depressed or you need the willpower to avoid a one night stand. Just Google "birth defects" and you'll lose your appetite. Best way to diet ever.

On a bit of a serious note, I can't imagine forcing a woman to deliver a child who was certain to die within 6 months. Gives me a new perspective into the choice versus life debate. I don't know what I would do myself, but I do know that watching my child slowly die would be one of the worst things imaginable.

But you know what?

It's all okay, because swans don't have these problems. Look at those cute swans.

She had like 5 babies at the same time and none of them are horrifically deformed. Sweet.
Focus, dag nab it! Must forget Genetics....

Oh wait. I have an exam on this material in a week. *sigh* Maybe I'll have forgotten about it by the time I'm trying to get pregnant.

The only thing stopping me from being too fearful to get pregnant is that nothing is worse than ADVANCED MATERNAL AGE! WARNING, WARNING, ADVANCED MATERNAL AGE HAS BEEN DETECTED. DO NOT PASS GO, DO NOT COLLECT $200.

Be back later, I need to go find my husband.

Sunday, September 4, 2011

I will wrangle a medical symptom out of you if it is the last thing I ever do

Our instructions for patient interviewing day:

"Try to get their chief concern. Ask abut any pain; try to get them to describe it. Really bore into the illness or complaint they have. Work on taking a medical history including past illnesses, medications, allergies. Then, if you have time, get some social history including home life, marital status, diet and exercise."

Here's how my interview went:

"Hello! My name is K8 and I am a first year medical student. We are learning how to interview; would you mind if I asked you some questions?"

"That's fine."

"Great. Can you tell me about if you have any medical concerns today?"


"Okay, perhaps you could tell me about the last time you went to the doctor?"

"I don't go to the doctor."

"Have you ever been to the hospital?"


"How old are you?"


(And you've never been to the hospital or the doctors....okay....)

"Do you take any medications?"

"Yes, I take medications for high cholesterol and for my eye."

(How did you get medications for high cholesterol?)

"Oh, what is bothering you with your eye?"

"Nothing. I take a vitamin to help it."

"Does the vitamin help it?"


25 minutes later, getting no further information about the high cholesterol or eye:

"What do you do for work?"

"I volunteer at the hospital. Ever since I had TB, and the hospital fixed me right up, I've volunteered there because they were so wonderful."


"Tell me about having TB."

"No, I don't talk about that. I tried to forget it ever happened."

"Alright then, thank you for your time. That's all the questions I have for you."


Don't get me wrong, I really appreciate these volunteers helping us hone our interviewing skills. But I could not get ANY information out of this person that my preceptor wanted. My preceptor said I gave it a gallant effort, and unfortunately, this type of conversation is very similar to what I will deal with as a physician.


In other news, let's mock the first year medical students interviewing skills, because seriously, this is how I feel: