Hi, my name is Akpa evelia. If you have not read Akpa gbator, it may be difficult for you to know me. But if you are brave anyway, here goes ...
Next up were Neurology, Psychiatry and Radiology. Neurology was a large field with many unknowns but it made a lot of sense to me. In many ways, it was logical. Like 1+1 = 2 and very rarely was it something else. It could be summarized in deficits or excesses. Deficits naturally were the easiest to see as in strokes when someone suddenly cannot use an arm or cannot feel temperature differences or touch on a part of the body. Reasoning through the losses and what normal function is, one can usually pinpoint which region of the nervous system the problem lies, something called “localizing the lesion”.
Excesses are much more difficult to notice. For example, when does an old lady who suddenly becomes hypersexual and happy come to attention or when does someone with repeated vocal ticks and a propensity to burst out in curse words realize it is Tourette’s syndrome? Much has been achieved in the medicine of the nervous system but a lot still needs to be done and I found it difficult to come to terms with the futility of a lot of it. We could determine what the problem was in most cases. We could not always treat them. One of my patients died with us knowing neither what caused his problem nor how to definitively treat him.
The most important thing I found in Psychiatry is we all have mental problems to an extent and if you dig below the surface, you could very easily come up with a diagnosis of yourself. It is also not for me. Radiologists are some of the smartest people in the medical field and not only because they make the best lifestyle decision of us all. The breadth of differential diagnoses they have to know is beyond belief and they know more than just the names, they know the pathophysiology and they know the best management practices. They are everyman’s doctors with no direct patients.
The best, and the reason I have been incognito for the past 3 months, was saved for last. Surgery was the light at the end of my proverbial third year tunnel. Since I was a child, I have wanted to be a surgeon. The simple idea of getting into a person’s body, fixing a problem and closing up like nothing had happened in the first place was just amazing to me. It is as good as instant gratification goes. As I grew, I got more and more excited about the heart. I saw a heart come back to life after being stopped for surgery and oh my! It was poetry in motion. But I jump forward. Let me rewind for a second.
My surgery experience ran the gamut from an attending telling me she would “take away [my] scissors if [I] cut like [I] did again” and duly taking it away on the next cut then not saying a word to me for the rest of the day’s surgeries outside of sending me to get her camera for a picture of an interesting pathology, through opening the six pack muscle to enter the abdominal cavity to resecting a lipoma, replacing a hip and suturing multiple incisions closed. Through all this, I never did tire of cutting into human skin…for good, of course.
I would have to say as a pre-clinical student, I thought watching a surgery was incredibly boring. I did not understand a lot of the pathophysiology, I did not know much about the procedures and in many cases, I could not even see what was going on. However, once I got into my third year and started putting together the link between pathology and physiology, it was easier to think through what procedures were going on, how the problem would be approached, why surgery was indicated in the first place and most importantly, the anatomy of the situation. In addition to this, I started looking at how surgeons exposed problem areas, how they were holding instruments and what instruments they were calling for during various parts of the surgery. And of course I thought through what the anesthesiologist was doing.
Let me tell you a typical day. I woke up at 4am, got to work by about 5am to pre-round on all patients on the team. This involved getting their vital signs, fluids in and out and for my patients, reading through the consult notes from the previous night, checking out on events overnight and writing a preliminary plan of action for the day. I was lucky to have another student, “Goose” to my “Iceman”, on the team and we could very easily divide and conquer. I felt the sting when he moved on to another service. We rendezvoused at 5:50am with the Intern and then rounded with the Senior (Boss – he hates it and this is the last time I will call him that) at 6am. Then we did “gravity rounds”; starting with the patient on the topmost floor and ending down on the surgical floor. Our role as we saw it as students was to get the patient charts, do dressing changes, get pimped (tested on multiple surgical and non-surgical knowledge) and in general make the morning a smooth and enjoyable one for our team.
7am saw us in rounds where we went through the trauma admissions of the previous night and the cases for the day and then we were off to the operating room of which you have heard enough. Suffice it to say, there was a totem pole and we were at the bottom of it. Our work mostly involved transferring the patient onto and off the OR bed, transporting them to the post-anesthesia care unit and in-between, cutting stitches and retracting other organs out of the way so the surgeons could get a better view of what they were doing and if we were so fortunate, getting further pimping. And NEVER contaminating the field.
And here-in lay the bane of the medical student’s OR existence. The circulation nurse. Yes I have been lucky to have the best of them. The ones looking out for you and the ones who were only vested in your success, helping you maneuver the OR adroitly. Yes I have also had the worst including those who invented more and more ingenious ways to charge you with being “contaminated”. You remember that totem pole in the OR? The circulation nurse, see, is on top of it. They are the people tasked with setting up the operation room, getting things and people moving and overall, making the operation a success. And they take their work seriously. If you are ever in an OR, make sure you have had your orientation and know who they are. Ask what you can do to help, get the temperature of the situation and act accordingly. One source that helped me with this is found here. Seriously though, a lot of them are very nice people who are more than happy to teach you and you should learn from them.
Back to the time line. Between cases, we checked on our patients “post-op” to ensure we did not screw up that physiology or the other anatomy. Then it was off to didactic lectures at 1pm during which we ate lunch. The rest of the day was spent either in cases, managing the patients on the floor or answering consult requests. We sign out to the night team at 6pm and go home to begin in another few hours. For the medical student, that meant dinner, and hitting the books for however long you spirit or body could take. Then sleep beckoned and before long, the annoying alarm goes off and you are back again.
As far as my personal experience, it was awesome. I have to say these were the most brutally honest people I have ever worked with and that was refreshing even if it meant there were harsh critiques half the time and I felt worthless the other half. I had, most of the time, teams with doctors who were committed to the philosophy of education and challenged my thinking, knowledge base and surgical skills. They also gave me a lot of responsibilities during cases, handing me large parts of the simpler cases and making me experience first hand, the art and science of what the French call Chirurgie. It is a time I will always cherish and most of the people will be remembered by me through my career. Above all, what made surgery great for me, and what keeps me excited about it, is seeing the problems in peoples’ bodies with my eyes and then seeing them solved. As one Senior said to me after we witnessed a ventricular fibrillation, “internal medicine doctors can only read about this in books”.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Showing posts with label medical students. Show all posts
Showing posts with label medical students. Show all posts
Tuesday, May 11, 2010
Friday, April 30, 2010
Musings from my time away – Akpa gbator (first part)
Hello, good day, how have yall been for the past 3 or so months? Yes, that is how long it has been since my last post and no one has been more cognizant of those months than me. However, since you, my loyal readership deserve better than spotty writing, I would like to apologize for my unannounced hiatus and ask that you continue with me as we resume this journey. So let me tell you what I did in the time I was away. The short of it is I completed my General Surgery Rotation to wrap up third year of medical school.
It was an interesting year overall, one of the greatest periods of growth in my life. The year begun with Internal Medicine which was three months of what can best be described as intense investigative work. The diagnosis, to be sure, was generally known to residents by the time the patient came up to the medicine floors from the emergency department. However, the student was required to work things out himself and from the often varied history elicited from the patient and the carte blanche physical exam of a beginning third year medical student, he was expected to formulate differential diagnoses and gather information to rule them out or in.
After extensive literature review, pimping (aggressive questioning) by resident and possibly senior resident, and for the lucky like myself, a lot of teaching, one was usually ready to nail the presentation and answer the questions to follow from attending physicians. This was what could be considered good reward for 5-page scholarly medical notes and 30 plus hours spent in the hospital often with little sleep every four days. But sometimes, things were not so rosy. Sometimes, you got lost in the details and stumbled through tedious notes that did little justice to the work you put in. Those times, one could get discouraged but there were luckily few of these occasions.
Obstetrics/Gynecology, ObGyn for short, was my next gig, my first surgical experience as it was. The birthing process was awe-inspiring and much more violent/terrifying than I had anticipated. It was a rather weird experience, not the most pleasant. Getting the privilege of delivering twins increased my appreciation of the pain my mother went through delivering my big-headed brother and sister twins with no pain control. But those crazy mothers were always so happy when they saw the babies and swearing to have others. I decided then never to get a woman pregnant.
I intend to become a cardiac surgeon so it was the surgical aspects of ObGyn that really appealed to me. Typically, the life of the third year medical student involved standing silently for hours on end, sometimes scrubbed which meant you could not even scratch an itch, watching the laparoscopic screen. It was mind-numbing at times but one lived to put a stitch through the skin and throw a few knots at the end of everything and if a harried pace made that impossible, it felt like someone had robbed one of his very soul.
Pediatrics rounded out the half year and is a memory better forgotten. I loved it, I did and I absolutely loved the little kids as well. But the one thing it came to show me was the need for self evaluation and the politics of the hospital and grading policies. It seemed the nature of the pediatricians I worked with was non-confrontational and accommodating, which was in line with the work they do and made them very good doctors. But this was not always the best environment for the student because what it fostered was a situation where students could not get the most straight forward feedback when they elicited it. You could thus find yourself doing the same things and garnering praise for them only to end up with rather lukewarm written evaluations which allowed people to say things they could not tell you in person. If nothing at all, it was an experience that would change my approach to third year and for the better, I’d argue. It also showed me my need for honest feedback, good or bad from working colleagues in my future practice.
In my next piece, I will tell you about neurology, touch briefly on psychiatry and radiology and a closer look into the workings of surgery. Ask me questions about the more details you would like to know and if the HIPAA laws allow it, I will let you know.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
It was an interesting year overall, one of the greatest periods of growth in my life. The year begun with Internal Medicine which was three months of what can best be described as intense investigative work. The diagnosis, to be sure, was generally known to residents by the time the patient came up to the medicine floors from the emergency department. However, the student was required to work things out himself and from the often varied history elicited from the patient and the carte blanche physical exam of a beginning third year medical student, he was expected to formulate differential diagnoses and gather information to rule them out or in.
After extensive literature review, pimping (aggressive questioning) by resident and possibly senior resident, and for the lucky like myself, a lot of teaching, one was usually ready to nail the presentation and answer the questions to follow from attending physicians. This was what could be considered good reward for 5-page scholarly medical notes and 30 plus hours spent in the hospital often with little sleep every four days. But sometimes, things were not so rosy. Sometimes, you got lost in the details and stumbled through tedious notes that did little justice to the work you put in. Those times, one could get discouraged but there were luckily few of these occasions.
Obstetrics/Gynecology, ObGyn for short, was my next gig, my first surgical experience as it was. The birthing process was awe-inspiring and much more violent/terrifying than I had anticipated. It was a rather weird experience, not the most pleasant. Getting the privilege of delivering twins increased my appreciation of the pain my mother went through delivering my big-headed brother and sister twins with no pain control. But those crazy mothers were always so happy when they saw the babies and swearing to have others. I decided then never to get a woman pregnant.
I intend to become a cardiac surgeon so it was the surgical aspects of ObGyn that really appealed to me. Typically, the life of the third year medical student involved standing silently for hours on end, sometimes scrubbed which meant you could not even scratch an itch, watching the laparoscopic screen. It was mind-numbing at times but one lived to put a stitch through the skin and throw a few knots at the end of everything and if a harried pace made that impossible, it felt like someone had robbed one of his very soul.
Pediatrics rounded out the half year and is a memory better forgotten. I loved it, I did and I absolutely loved the little kids as well. But the one thing it came to show me was the need for self evaluation and the politics of the hospital and grading policies. It seemed the nature of the pediatricians I worked with was non-confrontational and accommodating, which was in line with the work they do and made them very good doctors. But this was not always the best environment for the student because what it fostered was a situation where students could not get the most straight forward feedback when they elicited it. You could thus find yourself doing the same things and garnering praise for them only to end up with rather lukewarm written evaluations which allowed people to say things they could not tell you in person. If nothing at all, it was an experience that would change my approach to third year and for the better, I’d argue. It also showed me my need for honest feedback, good or bad from working colleagues in my future practice.
In my next piece, I will tell you about neurology, touch briefly on psychiatry and radiology and a closer look into the workings of surgery. Ask me questions about the more details you would like to know and if the HIPAA laws allow it, I will let you know.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
Saturday, August 29, 2009
Don’t Say Goodbye
This is a reflection on an experience I had some time ago in its raw, non-edited form. It shows a bit of what the student life is and the little joys we get from it.
There was a smile on the mother’s face as we left the room. I had been in there with my fellow second year student as part of our pediatric session for the Patient-Doctor experience (PD) and he had happened to be the last patient we saw that day.
I must first admit that I have been on e of the many students that have smirked in disdain as our preceptors tried again and again to justify the saying of catch phrases like “that must have been hard for you” to patients. I understood the need for empathy towards the patient but I also knew the patient’s primary goal was to get treated. And as a second year, my aim was to learn the ropes for survival during third year and that involved learning about diseases, procedures and doctor preferences.
The morning was rather slow this Wednesday and we saw about two patients, one very quiet and needing little persuasion to consent to procedures, the other hyper-excitable and having more fun in a hospital than I had ever seen anyone have. In both rooms, I played the game of peek-a-boo while the physician and or resident got what they needed for diagnosis from child and mother alike. In the room of the third patient, we morphed from clowns into strong men holding down a child as a venous line was placed in her vein to hydrate and nourish her. I was learning. My day was getting productive but not as productive as it would in the next few hours.
My colleague and I had been discussing how best to get out early from the rather quiet ED (emergency department) to study for the STEP I exams when the cardiac monitor started screaming in protest. The beeps got louder and the rush of footsteps past the staff room indicated a major event was happening. Before we could rush into the room, the door was closed and we were left to rue a missed opportunity.
SVT, I heard them say. And with that I went to the still complaining monitors to conduct my personal consult. It was no SVT since there was no sinus rhythm but there was tarchycardia alright, 240 beats per minute in a child and all I could think of was what a unique opportunity this was to see theory in practice. The loud cries coming from Room 3 blended into one with the beeping of the monitor in front of me and both played in sync with the ups and downs of the EKG baseline and the cluttering and smoothening of the rhythm strip as I stood intently looking for the P wave before the QRS complex and arguing with my colleague about whether the initial upstroke was the P or whether there was a bundle branch block.
Finally, we got our chance or let me say, I got my chance when the cardiologist was brought down for adenosine therapy and my colleague volunteered to interpret the Arabic that the mother spoke. I saw a little boy in obvious pain with his face buried in his mother’s bosom and the hand he could use digging into the winter coat that she apparently was oblivious to the fact she was still wearing. And in the eyes of the mother, I saw not just pain and despair, but confusion—confusion about what was going on and probably confusion from being listening to what was being discussed around her and not understanding a single word of it.
We took our positions in the far corner of the room out of the way of the hurried masses and looked on silently while the professionals went about their work. I attempted my game of peek-a-boo again but where it held the first patients attention throughout our visit to her room, it caught this one’s only for a second. I watched my colleague communicate the findings and plans to the mother and repeat her questions and consents to the attending. I did not comprehend what they said to each other but from her mannerism, she seemed to trust in what the doctors were doing and only wanted her son to be free from suffering. First, a bolus of Midazolam was administered to calm the still remonstrating child and then preparations were made to administer adenosine in the hopes of getting him out of his arrhythmia. With each dose, he looked on first in calm and then as the medicine made its way to his heart he would writhe in pain and attempt to reach for his mother who stood holding his hands and brushing his hair with the other while tears run from both eyes. I turned and whispered to my friend to tell her everything would be okay, to “do what we are told to do in PD” but he was an interpreter. Was it really his place to do that? I was of course still jesting and I was still wracking my brains on what the mechanisms of action of adenosine and midazolam were but there was something else dawning on me that many hours in my PD lectures had not convinced me about—these two people were concerned not only about the treatment being administered. They wanted hope against hope that everything would be fine.
The adenosine intervention ultimately failed and the patient had to be transferred to the surgical intensive care unit. While preparations were being made for this and an ultrasound was sought to observe heart structure and function, there was a temporary lull in affairs and I went over to hold the boy’s hand. He held my finger tightly while I said to him that he was going to be fine without knowing whether he understood me and praying that he would be alright. We stood there silently watching each other and saying nothing more but understanding that a connection had being made that was essential to the humanity of both of us. The ultrasound came and left without him letting go of my finger and another cardiologist who could speak Arabic came and left and he would still not let go of my finger. Finally, at 5:30pm, 30 minutes past our check out time and with every thought of studying for the upcoming boards out of my mind and concerns about p-waves and inverted t-waves nowhere near the forefront of my consciousness, I was able to extricate my hand and mumble a good luck to the mother. At the door, I turned and waved. Bye S., I said. With the IV lines still in place and the EKG leads hanging off his chest, he turned to look at me, raised his hand slightly off the bed, and waved in return. At that moment, a lightness descended on me and for the first time that late afternoon, I saw a smile in the mother’s eyes and about her lips. Then I realized I was smiling as well.
On my way out of the ED, I could hear the cardiac monitor still shouting its revelations to anyone that would listen. But in Room 3, a silence had descended; a brief respite from what would most likely be another frantic few hours.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
There was a smile on the mother’s face as we left the room. I had been in there with my fellow second year student as part of our pediatric session for the Patient-Doctor experience (PD) and he had happened to be the last patient we saw that day.
I must first admit that I have been on e of the many students that have smirked in disdain as our preceptors tried again and again to justify the saying of catch phrases like “that must have been hard for you” to patients. I understood the need for empathy towards the patient but I also knew the patient’s primary goal was to get treated. And as a second year, my aim was to learn the ropes for survival during third year and that involved learning about diseases, procedures and doctor preferences.
The morning was rather slow this Wednesday and we saw about two patients, one very quiet and needing little persuasion to consent to procedures, the other hyper-excitable and having more fun in a hospital than I had ever seen anyone have. In both rooms, I played the game of peek-a-boo while the physician and or resident got what they needed for diagnosis from child and mother alike. In the room of the third patient, we morphed from clowns into strong men holding down a child as a venous line was placed in her vein to hydrate and nourish her. I was learning. My day was getting productive but not as productive as it would in the next few hours.
My colleague and I had been discussing how best to get out early from the rather quiet ED (emergency department) to study for the STEP I exams when the cardiac monitor started screaming in protest. The beeps got louder and the rush of footsteps past the staff room indicated a major event was happening. Before we could rush into the room, the door was closed and we were left to rue a missed opportunity.
SVT, I heard them say. And with that I went to the still complaining monitors to conduct my personal consult. It was no SVT since there was no sinus rhythm but there was tarchycardia alright, 240 beats per minute in a child and all I could think of was what a unique opportunity this was to see theory in practice. The loud cries coming from Room 3 blended into one with the beeping of the monitor in front of me and both played in sync with the ups and downs of the EKG baseline and the cluttering and smoothening of the rhythm strip as I stood intently looking for the P wave before the QRS complex and arguing with my colleague about whether the initial upstroke was the P or whether there was a bundle branch block.
Finally, we got our chance or let me say, I got my chance when the cardiologist was brought down for adenosine therapy and my colleague volunteered to interpret the Arabic that the mother spoke. I saw a little boy in obvious pain with his face buried in his mother’s bosom and the hand he could use digging into the winter coat that she apparently was oblivious to the fact she was still wearing. And in the eyes of the mother, I saw not just pain and despair, but confusion—confusion about what was going on and probably confusion from being listening to what was being discussed around her and not understanding a single word of it.
We took our positions in the far corner of the room out of the way of the hurried masses and looked on silently while the professionals went about their work. I attempted my game of peek-a-boo again but where it held the first patients attention throughout our visit to her room, it caught this one’s only for a second. I watched my colleague communicate the findings and plans to the mother and repeat her questions and consents to the attending. I did not comprehend what they said to each other but from her mannerism, she seemed to trust in what the doctors were doing and only wanted her son to be free from suffering. First, a bolus of Midazolam was administered to calm the still remonstrating child and then preparations were made to administer adenosine in the hopes of getting him out of his arrhythmia. With each dose, he looked on first in calm and then as the medicine made its way to his heart he would writhe in pain and attempt to reach for his mother who stood holding his hands and brushing his hair with the other while tears run from both eyes. I turned and whispered to my friend to tell her everything would be okay, to “do what we are told to do in PD” but he was an interpreter. Was it really his place to do that? I was of course still jesting and I was still wracking my brains on what the mechanisms of action of adenosine and midazolam were but there was something else dawning on me that many hours in my PD lectures had not convinced me about—these two people were concerned not only about the treatment being administered. They wanted hope against hope that everything would be fine.
The adenosine intervention ultimately failed and the patient had to be transferred to the surgical intensive care unit. While preparations were being made for this and an ultrasound was sought to observe heart structure and function, there was a temporary lull in affairs and I went over to hold the boy’s hand. He held my finger tightly while I said to him that he was going to be fine without knowing whether he understood me and praying that he would be alright. We stood there silently watching each other and saying nothing more but understanding that a connection had being made that was essential to the humanity of both of us. The ultrasound came and left without him letting go of my finger and another cardiologist who could speak Arabic came and left and he would still not let go of my finger. Finally, at 5:30pm, 30 minutes past our check out time and with every thought of studying for the upcoming boards out of my mind and concerns about p-waves and inverted t-waves nowhere near the forefront of my consciousness, I was able to extricate my hand and mumble a good luck to the mother. At the door, I turned and waved. Bye S., I said. With the IV lines still in place and the EKG leads hanging off his chest, he turned to look at me, raised his hand slightly off the bed, and waved in return. At that moment, a lightness descended on me and for the first time that late afternoon, I saw a smile in the mother’s eyes and about her lips. Then I realized I was smiling as well.
On my way out of the ED, I could hear the cardiac monitor still shouting its revelations to anyone that would listen. But in Room 3, a silence had descended; a brief respite from what would most likely be another frantic few hours.
Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************
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