Cadaver Ball

AKA Med School Prom.  

I am not sure why they call it Cadaver Ball, but it is the same at just about every medical school.  The second-year class rents out some big fancy venue, hire bartenders and sell tickets, and then everyone gets all dressed up and goes out to dance.  This year they rented out the Fernbank Museum, which was really cool- our dance party was under the huuuuge dinosaur skeletons!

Pre-gaming at Megan and Mihir's house.  Good friends, good beer, good food...

we almost didn't want to go to the main event.

 I love the way Megan laughs... hard and loud.

 My shoes/tights combo... loved it. :)

Letting Chelsea play bartender. 

Dinosaur time!

Pulmonology

First of all, let me just tell you that medical school gets so much more interesting once you finally get to start learning about medicine.  SO much more interesting. 

But.  Most days it still feels like school to me.  Which, for whatever reason, at this stage in my life, is having the strange effect of eliciting revolt from just about every part of me: my will, my attention, my mood, my alertness, my social impulses, my sleep needs, my bank account.  Unceasing mutiny on my desire (which, thankfully, does still exist) to be a doctor.

I am still not quite sure why I have not ever, since I moved here and started at Emory, felt like I have found my groove, or totally gotten into the med school mindset.  During my postbac year, I thought nothing of sleeping very little, hanging out with friends even less, going for weeks without talking to loved ones on the phone or shopping or going out to eat dinner at a restaurant, but this year I have been fighting it tooth and nail, living in a strong, strange denial that this is what medical school requires.  The way that I have explained it to a couple of people recently that that I used to have a life, and I miss it.  

Anyway. 

We are in our pulmonary medicine module right now, just finished week four of five.  (Side note: am I the only one who cannot believe how fast the year is flying by??!?)

Last Thursday was one of the best experiences I have had in med school in months.  The module director assigned us in small groups to hang out with a pulmonology fellow for an afternoon in the Emory hospital.  The idea was that they would take us around and let us listen to some abnormal lung sounds, which are really difficult to understand until you actually hear them in real life.    

It has always been the interactions with patients as real people that have most inspired me and reminded me of why I am here to do this in the first place, and Thursday was a much needed refresher for me.  

One of the patients we saw was of interest to our fellow because he had a hemi lung transplant, and he wanted to give us a chance to listen to the transplanted lung and compare it, side by side, to his "original" one.

He was a 66-year-old man; a sweet, soft-spoken old-school Georgia farmer.  He had worked hard by himself on his own farm all his life.  He described himself as basically healthy, but had a splenectomy at as a child, suffered kidney stones, developed idiopathic pulmonary fibrosis, which necessitated a lung transplant, then heart disease, heart attack, pacemaker inserted, kidney failure, cancer twice (the second time was the reason he was currently in the hospital) had his ear removed along with his cancer, and got Bell’s palsy (paralysis of half the face) as a result of that surgery. 

Lung transplants are really interesting- I never really knew that much about them before.  This patient that we met was transplanted 12 years ago- by lung transplant standards this is a remarkable success story, given the fact that he is still alive.  He never smoked in his life, but developed a terrible disease called idiopathic pulmonary fibrosis (IPF), which basically means that the tissues surrounding the tiny air sacs in his lungs became progressively fibrotic and stiff- thus making it progressively more and more difficult for him to breathe.  Idiopathic means that there is no real known cause.  Prognosis for patients with IPF is poor- without a lung transplant, almost all patients die within five years of diagnosis. 

The lungs are the filter of the body- one of your first and most important lines of defense against infectious agents.  In order to get a lung transplant, however, the number one factor for matching potential donors and recipients is height.  The lungs have to be roughly the right size.  So in order for the transplant to work, the patient has to be massively immunosuppressed, so that their bodies don't reject the transplant- at least, not right away.  Eventually, all transplants will be rejected, while, in the meantime, the weakened immune system can't fight off other disease processes, and patients suffer from frequent, serious complications.  Lung transplant is the last resort for someone with lung disease.  At best, it buys you more time.  Usually, though, most of the time it buys for people is spent in hospitals.

As we listened to our patient's breathing, the difference between his two lungs were striking: his original lung was thickly and loudly crackling, almost bubbling, from his IPF, and the transplant sounded much clearer- although it, too, had a distinct wheezing (a sign of rejection, the fellow would later inform us).  The patient dutifully and patiently let all ten of us shuffle through, put our cold stethoscopes on the bare skin of his back, listen for whatever it was we thought we were supposed to be hearing, thank him awkwardly as we moved to the back of the line to let the next student through.  

What was most amazing to me about this encounter was the way he told us his story: he married his very sweet wife, had two boys, worked his farm... his wife teased him that he had been sick their whole married life.  Despite everything that he has been through (all of his very significant medical issues in the past twelve years can be at least indirectly attributed to his transplant), he told us that it had all been more than worth it, because he got to raise his sons, see them graduate from college and become teachers and EMTs, and he was proud of the men they had become.  He was glad than he had been able to share those years with his wife and that he had been able to keep working.  There was no bitterness at all.  At the end of our visit, before we all trooped back out of the room in a long line, he thanked us for studying medicine, adding that even though he wouldn't be one of them for much longer, people needed us.  

It really choked me up.  And made me feel sort of ashamed... it is so easy for me to lose perspective on the motivation that got me here in the first place.  I am not sure why I am always surprised when people express gratitude for those who choose to go into medicine and dedicate their lives to helping others, but I always am.  And I always feel uncomfortable when I am the one on the receiving end of those comments.  Of course, in my better moments, I remember that this is a calling, that it is a deeply felt desire of my heart, that I truly believe in it, and I believe that it really matters, otherwise I would not have been interested in pursuing it.  But most moments of the day, that is just not where my head is.  I think that the same good intentions and genuine motivations are true of most of my classmates, as well, but... we are all very human, and I am definitely no exception.  I am always tired, I like to complain about bad lecturers and boring classes.  I envy my friends who work 9 to 5 jobs and get to do what they want on the weekends.  I study to pass my tests, but I don't put in the extra effort to make sure that I know the material to the fullest extent that I possibly can.  I judge classmates for being young and immature, but I am often just as self-involved.  I am easily distracted and waste hours doing stupid stuff when I should be learning instead.  Because it is important.  Because someday, people will need me.  I am grateful for these interactions that serve as reminders for me; they refresh my love for being here and being lucky enough to study medicine.  And they also make me feel really nervous, which is probably a good thing.

Old Friend, New Love

Stay tuned.  (Much) more to come...  :)

28.

Monday was my birthday.

Not to get all cheesy and disgusting about this (but I guess this is my blog and if I can't do it here, where can I...?) BUT: it was an amazing weekend, and I am stunned by happiness.

It was a post-test weekend, which meant that everyone from school was free, which meant that there was lots of partying, which meant lots of eating and drinking and dancing.  Dinner followed by dance party on Friday; yoga, cookout, beer festival, pub, dance party on Saturday; lots and lots of cooking and then about 18 incredible women over to my house for dinner on Sunday; coffee date followed by yoga followed by dinner followed by wine bar on Monday.  

The entire weekend was one social event after another, and the reason I am gushing about it is that I just feel so absolutely, incredibly blessed to have such amazing people in my life.  My classmates and friends in school are wonderful and SO much fun.  I have come to be surrounded by this incredible group of women, mostly from school, and some from other random connections.  Messages from friends far and wide, phone calls and video chats with my family... it was nothing but love, love, love.  I must be the luckiest girl on earth.

From JAMA

Holding the Hand

1. Jordan M. Gutovich

With the completion of my final neuroscience examination, I expected to experience a feeling of relief. It was the last exam of my first year of medical school. I dreamed of finally being able to relax from the academic rigors and responsibilities that notoriously define one's first year as a medical student. That sigh of relief did not come readily. As I made my way out of the building I decided to pass through the medical library. There, my second-year colleagues were engrossed in preparing for their Step 1 boards. I swallowed deeply with the realization that this would be my last summer of freedom. Still, I had hopes that this summer break would allow me to regroup and spend more time with my wife Riki and our 2-year-old son Yehuda. I also had hopes that I might steal some time to write about some of my experiences of the past year.

The majority of my first-year courses were stimulating and engaging. I found neuroscience and immunology especially interesting, but my favorite was called “Physician and Patient.” The course objectives included acquiring a better appreciation of the social and cultural context of a patient's disease and placed special emphasis on how to conduct a thorough medical interview. For example, we learned how and when to use open-ended or close-ended questions, how to allow patients to tell their story with minimal interruptions, and how to experience and display empathy toward our patients. While each week was packed with lectures and labs that revolved around the basic sciences, there was an island in the middle of the week, a two-hour sanctuary of time that was dedicated to learning about working directly with patients.

Standardized patients were provided to help us practice these skills. However, nothing beat the real thing. Several times a month we had the opportunity to visit the hospital where one student in the group would conduct a thorough interview with a patient while the others watched and listened. Finally, in late December, my turn arrived. Our group waited outside the patient's room while our instructor, Dr C, checked the patient to determine if he was well enough for and agreeable to our visit.

As we waited outside, I reviewed again the long list of questions that we had been urged to memorize. I was confident I would be able to navigate the patient through a complete clinical interview, beginning with the account of the reason for the hospitalization and concluding with questions about his sexual history. After several moments, Dr C motioned to us to enter the room. Taking a deep breath, I led the way followed by my three classmates. As I rounded the corner, I caught my first glimpse of the patient. Mr B was a 64-year-old man whose thinning gray hair lay across his forehead. We gathered in the room, congregated around the patient's bed, and, without speaking, Dr C indicated it was time for me to begin. I approached Mr B, extended my hand, and introduced myself. To his left stood a nurse who was preparing an IV bag of chemotherapy drugs that she would later attach to an abdominal port catheter. I started by explaining that we were first-year medical students and that I hoped he wouldn't mind if I asked him some questions about his illness. Mr B replied that he was happy to participate. I started at the beginning of his illness and he told me that he had been readmitted to the hospital for the treatment of a recurrence of his cancer. As he told his story, he pulled up his loose hospital gown and exposed his abdomen, showing us a scar from a prior surgery, which had resulted in the removal of an abdominal tumor.

As I proceeded with the interview, I concluded that aside from the nurses, we were probably Mr B's first visitors that day. I wondered about his family, which he had not mentioned so far. A bit later, I asked him if any of his family members had visited him since his readmission. In a stoic fashion, he answered that he had admitted himself to the hospital a week before to undergo his current chemotherapy regimen and he had pressed his wife to stay behind. He reported he did not feel it was worth his wife's time to stay with him. He reasoned that he would be home in a week's time and strongly encouraged his wife to avoid missing time at her job and to take care of their house.

On the one hand, Mr B's composure, strength, and determination impressed me. At the same time, it seemed paradoxical. How was it possible for him to cope with a cancer recurrence all by himself? My curiosity got the better of me. I decided to deviate from my memorized list of questions and to explore gently his professed independence. After taking a moment to find the appropriate words, I said, “Mr B, your courage has impressed me and I admire your determination and strength. Can you share with us what it is that is carrying you through this challenging period in your life?” The question had barely left my mouth when his expression changed. The hard lines of his face and the rigidity of his trunk seemed to soften. It seemed like my question had struck a deep chord within him. He briefly glanced up at the ceiling and after a few moments, he looked back and confessed, “The hope of going back into remission is what's carrying me through all of this.” He then began to cry.

Earlier in the year I had observed Dr C holding the hand of another tearful patient. After that patient encounter our group discussed with her the pros and cons of a physician taking hold of a patient's hand. Some of us were more comfortable with doing so than others. Some students expressed concerns about the appropriateness of holding a patient's hand and whether doing so might be deemed an intrusion into the patient's personal space. After facilitating a discussion about the matter, Dr C concluded that a physician has to use appropriate judgment and be personally comfortable with holding a patient's hand before extending his or her own.

There I was sitting next to my crying patient. I was at a loss for words to respond to my patient's tearfulness. Instead, I took his hand and held it firmly. He gently squeezed my hand in reply. The room was briefly silent. Somehow, my gesture, I believe, seemed to confer a wordless message of support and encouragement. Eventually, after a few moments, Dr C stepped forward. She thanked Mr B for his time. Our group wished him well, and we moved into the hall. I was the last to leave. As I did so, I looked back at Mr B, briefly bowed my head, and waved my hand as I stepped outside.

During the first year of medical school students are required to master a tremendous body of knowledge that forms the bedrock of understanding human biology and pathology. In basic science courses students are primarily asked to memorize and integrate information that will later help shape how we approach clinical problem solving. However, courses on doctoring and the opportunity to interact with patients also provide us with essential tools to explore the interpersonal fabric that exists between physician and patient; and help us understand how to provide comfort to patients as they attempt to cope with serious illness and impending death. While I have enjoyed the vast amount of science that I have learned this past year, the most memorable and the greatest lessons from my first year of medical school are embodied in this sort of encounter. I suspect that it may take a whole career to master the science of disease and balance it with both the science and art of patient interaction. I am therefore grateful to have already embarked on that journey and look forward to continuing the exploration for the rest of my career. The summer now awaits me; Riki and Yehuda need my attention.