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.