Finally, pictures!

Okay, this is disorganized.
Brace yourself
for an asynchronous jaunt through recent history.
In no particular order:
At Mimi's 80th...
Mimi and I mug shot,
Vivian with a smile,
and Grandpa and Mazie playing tictactoe.
The back door at our apartment, including corn plant that was here when we got here. Last (chronologically), but not least, Mazie and Vivian all dressed up for their first day of school - Mazie to 1st grade and Vivian to Pre-K.

I have noticed that I keep having to explain how cool my stepdad is. Pete, you're cool. I keep having to tell people all about Pete and I wish I could just show him off. December, maybe?

Learning secrets

I often have the feeling that I'm learning secrets - Deeeeep Secrets of embryonic and fetal development. What we (think we) know is pretty amazing. The body of research supporting a single finding such as "We used to think the nerve cells told the muscle cells whether to be fast- or slow-twitch, but now we know that the cells' fates are determined significantly before the nerve cells ever reach them" represents one study, maybe more. The embryology book is filled with such statements. I won't go into the more esoteric of them, but basically when an embryo is growing and the tissues are differentiating, the cells tell each other what to do in a precise pattern that depends on the signaling cells' history and gene expression. And the cells instructed ("induced") by those signaling cells go on to make their own signals for cells further downstream and so on. The point I'm making is that EVERY step we (think we) know had to be teased out from all other steps using the scientific process.

And I get to learn about it.

(Powerpoint is not presenting nearly as profound a problem as it previously had. I print.)

Girlies and Richie await, so adios!

It’s been three weeks since I have last posted anything substantial. That’s because I’ve been doing only the things that need to be done for the past couple of weeks.

At this phase (Healthy Human), we have a quiz every week. I’ve had a quiz the last two Fridays in a row. The first week was really difficult. The content was less challenging than the adjustment to the style of learning. At the beginning of each module of healthy human (modules last between 1 and 3 weeks), the module directors give us a list of reading and learning objectives for each lecture. I read the corresponding material before lecture. It turns out that our lecturers are often whatever experts the module leader could scrounge up from among Emory’s faculty and affiliates. We’ve been really lucky to have people teaching us who are not only familiar with, but who also engage in, the most recent literature on the topic we’re studying. This situation subverts the paradigm of “The book is the expert and the professor follows the book.” In our case, our lecturer gives the last word (at least as far as our test is concerned J. Their emphases may depart significantly from the book. If a student asks a question, the lecturer is usually familiar enough with the topic to discuss the limits of knowledge about the answer.

So, obviously, this is a really neat way to learn. It means that the Powerpoint slides the lecturer shows are of primary importance to us. That’s the crux of my remediation for the last two weeks: for me, the transition from paper-learning to screen-learning has been challenging. I learn best if I can touch or “own” the material. A lot of the way I remember when I’m taking a test is visual. I remember context (where I was when I read the bit) and I remember position on the page. I remember diagrams and pictures really well, but the words also form a sort of diagram for me in the topography of a physical piece of paper. The great thing about typed text, a consistent graphic design, and a glowing screen is that they make things easy to read. The bad thing is that it’s all the same and you can’t draw circles and arrows and flip through it. Info on a screen is a lot harder to own.

It took me about three days to get out of frank denial that I was going to have to Do Something about the info on the Powerpoint slides. The solution seems to have worked for me: I print out the slides six-to-a-page before lecture so that I can scribble right on the slide and take notes directly on the page. I didn’t have this system worked out week-before-last, and so I was exquisitely uncomfortable with the way I had been learning. There were tears and no small amount of fussing. But I did fine on the exam and also developed my system for owning the material. This past week has been easier for me. I am an old dog learning new tricks.

The material, by the way, has been pretty cool - human development, embryos, and tissue types. We’re also learning to do the patient exam. I got to feel my friends’ abdominal aortas and they felt mine. It’s pretty easy: one of you lies down on your back, relaxed, and the other presses quite firmly (it doesn’t hurt) deep into the abdomen (near your belly button). You’re feeling for the pulsing aorta. It’s big and strong, so get ready for a surprise. I’m learning percuss a chest to listen for consolidation (junk that should not be there) in lungs and for the position of the diaphragm. I’m also still learning to use my otoscope/ophthalmoscope and my blood pressure cuff. A healthy ear drum LOOKS healthy. So cool.

Stuff is happening

So quickly that I can't get it all in this blog AT ALL.

An amazing patient presentation brought home the necessity of caring how we interact with patients - the subtle things - from the patient's perspective.

We had a talk on violence today.

I got my medical equipment in the mail today!!!! If only I could figure out how to turn on the otoscope! But I have to admit, I'm getting pretty decent at taking blood pressures :).

And a wonderful M.D./professor talked to us about health care reform today. I understand more than ever, though I wouldn't call myself an expert on the subject.

Finally, Richie has gone to bed, so I better get there too or I'll not get read to!

Best!

Hello! Right now it's naptime at my house. That means the girls are listening to Kids' Sing and Dance - a maddening CD that is exactly what it sounds like it is. The singers have British accents, which makes me miss Paul Musselwhite reading in church :). I got off early because today we just did a debriefing session about Week on the Wards with other people in our small groups.

I'll go ahead and explain small groups. One of the goals of the new curriculum is to give medical students a longitudinal exposure to great clinicians. To that end, we are divided into four "Societies" and further divided into small groups of about 9 each. Ours has nine: Jenna, Shiva, Emily, Laura Jane, Steven, Jonathan, Jonathan, Robert, and me. Our leader is Dr. Mary Jo Lechowicz, an oncologist who does bone marrow transplants. Our small group does lots of things together and is the principle venue for discussing everything from medical ethics to unexpected squeamishness. We'll learn physical examination techniques from our leader and will practice on our fellow small group members. We are told that we become quite close with our small groups whether or not they're people we naturally group up with.

So, on the clinical side of things... What did I learn this week? I learned how wonderful it is to be taught any little thing by someone who knows more than you do. Our upperclassmen med students were very helpful on our week on the wards, taking every opportunity to explain what they were doing and how it fit into the larger picture. Thank goodness, because for all my clinical experience, a lot that I saw was new. One of the frustrating things - no, THE most frustrating thing - about scribing was my mandate not to ask questions for fear of interrupting the flow or slowing down the doctor. It's 180 degrees different now that I'm being trained. We have to ask questions. The catch is, when I'm in the position of the medical students and residents, I'll have to have all kinds of knowledge on the tip of my tongue.

For example, here's an approximation of a back-and-forth between the attending teaching physician and a fourth-year med student (who is, for all intents and purposes, Medicine Superman):

Dr. J: And so when you look at these lab values, what can you tell about the patient's thyroid?
4th year: It's underactive.
Dr. J: We don't have the T3/T4 breakdown, but if we did, what would we see?
4th year: Normal is between (??) and (??) (he knew); hers would be somewhere around zero.
Dr. J: Exactly right. Does anybody know what the first thing we need to do for this patient is to make her more comfortable before the thyroid replacement therapy has a chance to kick in?

They knew. Some knew faster than others, but they all knew.

Internal Medicine is really cool. I didn't witness a single procedure, but the team thought through every complaint, lab value, possible drug interaction or side effect, coordinated care with social workers, consulting physicians, nurses, and therapists VERY carefully under the expert guidance of Dr. J. I liked the thinking-through. Dr. J. was very current with the research and was constantly bringing the available evidence into the decisions she was making. She also did something I haven't seen much of outside of Dr. Heideman's classes - that's critique scientific literature for sample size, question asked, holes in the methodology, etc.

This was a very cool week. I loved the things I got to learn about. I added an image of one of the symptoms of OVERactive thyroid - Graves' ophthalmyopathy. That means eyemuscleproblem. One of our patients had bulging eyes. She eventually came to the clinic because her thyroid gland was so large that she couldn't swallow normally and couldn't sleep on her back because the huge thyroid gland (goiter) compressed her airway. She ate all the time and couldn't gain weight. She was extremely irritable, hot, and shaky. We also had a patient with hypothyroidism who had slowed down to the point that she could no longer care for herself. Her symptoms were exactly opposite of those of the lady with hyperthyroidism. Both problems are very fixable, but deadly if left untreated.

I saw other patients with problems that weren't fixable. Those were very sad, but everyone was doing their best to help.

Grady is old and tech-slow (which don't make a huge difference), but was difficult for the providers for two related reasons: volume and slow response times from staff. I'm not sure how it got this way, but tests and imaging studies got performed slowly on average and sometimes not at all. There seems to be a culture of expecting the worst. One lady complained of getting her pain medication too frequently and the medical team exchanged an incredulous look among themselves. The resources and/or oversight are simply not there to make sure things run in an ordered fashion. Sentara, by contrast, had a huge system of checks and balances that irritated the heck out of the nurses who felt they were jumping through hoops but which I suppose ensured that things would run smoothly and quickly.

Anyway, I'm home early today! We're trying to get the house cleaned early so we can have fun (and finish the final things on my list) for my last weekend before classes officially start.

I made it!

Week on the Wards (at the giant hospital shown) is finished. We go to school (the smaller building with grass) tomorrow to debrief.

Okay, it was really cool. My biggest problem was GETTING to and from the hospital. I got there every day, but rarely in the way I planned. The first day, as I described, was golden. Shuttle there and shuttle home with no hitch. The day after (Tuesday) was great in the morning because Richie and the girls drove me. But Tues was a problem in the afternoon because I didn't have a great understanding of the shuttle schedule and so missed the shuttle from Grady to Emory and had to wait almost an hour for the next one. Then I waited a long time at Emory for the connection home (should've walked at that point- 20/20 hindsight), making my entire trip about an hour and a half. Blech.

Wednesday was probably the biggest morning foible. I was determined to know the route and timing and spent considerable time on the internets the night before trying to get it all worked out. Long story shorter, I tried to take the shuttle but got as far as school before I realized it would never work. So I called Richie, who picked me up. On the way, we parallelled my attending physician on Dekalb Ave, so I switched cars and rode the rest of the way in with her. Lucky break. In the afternoon, I actually got out just in time for a shuttle and had to wait just a little while.

Now we're up to Thursday. Wednesday night I was again determined to make it work a better way and save gas and Richie's time. So I decided to bike. It's about 6.5 miles from here to downtown, where Grady is. I planned my route carefully according to roads and neighborhoods I'm familiar with. Only some of the trip is through a rough neighborhood. Those of you familiar with Atlanta or good on Gmaps, it's North Decatur to Oakdale to Euclid to Edgewood. This morning I had no idea how long it would take me accounting for road quality, hills, and traffic. Specifically, here, I thought about hills, but hadn't really considered hills that well.

I had fantasized (while waiting for the shuttle at some point, I'm certain) about a flat, straight shot to Grady where I could control my departure times. I forgot entirely about hills when I budgeted time. So, this morning, imagine my surprise when I hit the first hill and started to huff and puff - slowly - up it. I started to get reeeeeally nervous that I hadn't budgeted enough time to account for hills, so I started biking just as hard as I could - pushing up every hill and getting up tons of speed on the downhills. I kept checking my watch's tiny hands to see how I was doing. I really couldn't tell because I didn't find a halfway point in advance or anything helpful like that. I could tell when I was getting fairly close, and I seemed to be in good time. All told it took 35 minutes at a dead sprint the whole way.

AND! The bad neighborhood is situated close to Grady, so that on the way there it's downhill and I can ride fast and on the way home I've just gotten on my bike so I can sort of zoom uphill.

In all, today was the most successful travel day I've had. I looked silly walking into the hospital in my mom's exercise shorts and a bike helmet, but I changed quickly and nobody could tell I'd looked so silly just moments before.

More on medicine in a little bit. Thanks for reading that long long account of my travel experiences!

On the Wards

Hi, everybody!


Emory SOM provides an immersion experience for the week after orientation called "Week on the Wards". It's meant to be a taste of what you're looking forward to. It grounds you in the reason you're learning all you learn in the next 18 months. It also, I've heard, gives you a benchmark so that later when you've had tons of experience and you actually understand the pathologies being discussed, you can say, "Wow, I sure have learned a lot since that first week on the wards."

Every M1 (first-year medical student) goes to a different rotation at one of five different Emory-affiliated hospitals. There's Egleston Children's Hospital, Emory Midtown (AKA Crawford Long), Emory University Medical Hospital (???), The VA, or Grady Hospital. So, today I received my marching orders for my Week on the Wards: Grady Internal Medicine Team 6. (Go team 6.) I'm joking because this has been the farthest thing from a competitive experience.

There's a shuttle from Emory SOM to Grady Hospital. It's about 5 miles, so it takes around 15 minutes with no traffic. The shuttle is a little like a roller coaster ride. My spacial awareness is poor enough that it looked to me like the shuttle was going to collide with every car we passed. The words "barrelling" and "careening" come to mind. I like the shuttle, though. I'm fairly certain I'd survive a collision and I basically give up care for life and limb and allow the shuttle driver to perform her drive. I did get fussed at for eating grapes, which I should've had the good sense not to do. Plus, since I hadn't realized I was breaking a rule, it took awhile for me to catch on that it was me she was fussing at.

(Resumed next day while at Grady Hospital computer lab on the top floor with the wraparound balcony and well-used lounge.)

This is FUN! I am on a team with (in order of descending responsibility) an attending physician, a head resident, an intern, a third-year med student, and a fourth-year med student. (And another M1 like me.) They are AWESOME. The attending physician is an excellent teacher. She's incredibly well-spoken and seems not to let a learning opportunity slide by without snagging it. The head resident is also neat...but I think he's currently in survival mode. He appears to be bleary-eyed, and we didn't see him at all yesterday because the clinic was busy. (I have no idea how this relates to his hospital duties or if he happened to stay up all night last night.) But he's definitely wry, direct, and good-natured. The intern has only been in her internship for three days, so she's brand-new and had her first (?) night of call here last night. She seems operable today, amazingly, though she said last night seemed busy to her.

Internal medicine seems to me to be medicine for adults, general, complicated. It's not a specialty (like neurology, oncology, dermatology, etc.). The patients we've seen have ranged from very, very sick to on their way out of the hospital. I actually am not quite clear on what I'm allowed to discuss in public, so I'll err on the side of safety and not discuss any specifics. I will say that every time I've been invited to listen or feel something on a physical exam, I've accepted with joy. I have also had to resort to my coping tactic of "You're about to cry; don't cry, don't cry, don't cry" which seems to be enough to distract me from the tragedy at hand.

I have to go, but I'll write more when I can. :)