med school has done some things to me

I read the word "infraction," and I thought it was "infarction" spelled incorrectly.

I am no longer weirded out by the idea of seeing a dead body.

I can't talk to someone without noticing details of their skin texture, any visible lesions, posture, gait, etc. I don't necessarily know what all I'm seeing means yet, but I know that it connects with their health history some way or other.

It occurs to me that I will have to actively stop myself from approaching people on the bus and telling them they should have so-and-so checked out if they haven't already.

I am starting to see people who are down and out as a collection of medical problems...and now I can imagine in more detail how miserable those dysfunctions make that person.

I am on the cusp of being useful in the medical setting. More on that and on something we call "OPEX" when I have more time...

Biking

So...biking. It's something most Americans learn to do at some point, and some of us love to go really really fast. Richie and I share a love of speed that I hope our kids don't share because it's dangerous. Just kidding - I want to ride roller coasters with them. Mazie has been a proficient cyclist for about a year now. She has recently taken to riding down the hill in "back" (we use that side of the apartment almost exclusively, so I think of it as the front) of our apartment building. She goes peeling down the hill at an angle, then makes the quick right-hand turn to just miss crashing into some concrete steps at the bottom. The first time I saw her do it, I almost peed my pants with fright. I realized she'd been doing it for a while; I had been out of sight range of where she'd been finishing her descent. (Bad mom; I know). She always wears a helmet and seemed to be pretty good at her maneuver. Plus, "Hill" is a generous term for the area in question. It's more of a "grade." Mostly, she LOVES going down the hill. So I let her continue to do it.

I remember last year when she was learning to ride. Mazie attacked the task of learning to ride a bike with the intensity of a fighter pilot. She was somewhere between "I-can't-do-this" and "Mama-I-can-do-this-myself" for about three months. We had a long run behind our last apartment, so I'd run beside her, steadying her bike and calling, "steer, steer, pedal, pedal!" She sort of loved it and sort of hated it. She was absolutely focused on the goal, but incredibly frustrated with the slowness of achieving it. Every session ended in tears of frustration. I finally learned to limit the sessions to about 7 minutes (both for emotional preservation and for the health of my lower back). Mazie would scarcely let me quit the session unless she had gotten to the crying point, and even then she'd want to keep going. Oh, man, was she tough. She was committed but sensitive, 100% focus. Eventually she graduated to a hand on her back, then to just a push-off. At last it was time to learn to start herself, which she accomplished entirely on her own when left by herself one afternoon.

And now she's careening down hills and biking ALL THE WAY around the lake with me.

Enter Vivian, stage left. She is learning to ride this year. Vivian, predictably, could not be more different than her sister. If Mazie is a fighter-pilot, Vivian is a surfer. Today she waited a full 45 minutes to receive help while I finished making chili and cleaning up the kitchen (Richie is at a computer class for his job)...no pushing. When I went out to help her this afternoon, her attitude is just the same as it's always been about biking: avid but relaxed. She'd bike along, wobbling her front tire crazily so that it almost went off the sidewalk on one side, then on the other, and then the bike peeled out and I caught her as she tipped to the right. She exclaimed, as she let out a deep breath, "Huh! That was fun!" And, yes, she wanted to try again. We looped around the apartment building. On the opposite side a family with little kids had left out at least 70% of their toys for the neighborhood to take a gander at. They're all spattered with mud and I think some haven't changed positions since we moved in last July. As Vivian rode past, she rubber-necked like crazy at their toys and veered off the road completely gawking at them. She does this a lot. When we went to the lake, we could barely keep her on task because she kept gazing: at the lake, at the birds, at dogs, and at other people. She'd gaze to one side and then veer off in that direction. Then she'd crash and laugh a sweet goober-ish laugh. But she's getting it...I think as fast or faster than Mazie did. She's at the needing a push-off, accompaniment, and occasional stabilization phase. I don't remember her ever crying about the process unless she falls and hurts herself. She is just a completely different person than Mazie.

I love them both so much! I really think I would not know who one is without the other and vice versa! They each make me a better parent to the other. Amazing.

Richie is so good to me.

The comment I get the most when I tell people that I have returned to medical school after nine years out with two children and a husband in tow is something like, "Wow. Brave. You must be very busy!" Right away I feel guilty because I know that my husband has absorbed 100% of what I no longer do. Last night, I came home a little late because I'd been practicing for my lab dissection demonstration (my "demo"), and he was in the middle of making a double recipe of lentil-chickpea stew. He told me to go into the living room and play with the girls. Not set the table, not help out in the kitchen; go enjoy our children.

After we had eaten the delicious meal of stew with bread and cheese, he took the girls upstairs and did bedtime routine with them so that I could study. Then he went to the gym and told me to leave the dishes for him. He came home and did the dishes. Then he stayed up until I was ready to go to bed - 11:45. This from a man who prefers a bedtime of 9:45. He stays up with me because one of the pillars of our marriage has always been to go to bed at the same time. It's like pressing the reset button on our connection for the day. Plus, and I am the luckiest person in the world because he reads me to sleep. (We are still working our way through Animal, Vegetable, Miracle.)

But last night I was extra-stressed because my demo was at 8 a.m. this morning and I have a test on Friday (that I am about to start studying for). So I was sad and I cried a little once I got into bed, mainly because of tragedy in the world and feeling inadequate and out-of-control. You know, the usual. Richie massaged my hair and told me it will be okay. Then he read me to sleep. He was so tired that he fell asleep in the middle of a sentence.

I assert that I am THE highest-maintenance wife this side of the Mississippi. Richie has served me extravagantly over the past several months; last night was one of many (most) where he bends over backwards to make things easy for me. I am so thankful.

So when people say, "Oh, you must be very busy," I immediately reply, "Actually, my husband is the one who really makes it possible. He does all the work." The more accurate answer would be that I am more well-cared-for than any other med student on the face of the planet. This is a team effort. Although I am the one actually enrolled in school, Richie is Team Captain. I love him. I LOVE him.

Brief update; pictures to follow

This morning is mostly typical of my weekend mornings. I tried to wake up at five to study, but since I stayed up til midnight studying, I got up at seven instead, when the girls woke me. Vivian was the first one out of bed. She had an accident this morning, a twice-a-year event that worries me about her continence and stress level, but not unduly. I think sometimes she just decides to go pee in bed. That's what she told me the last time she peed in bed. Anyway, this morning she shuffled into our room at about 6:30 to let me know she had had an accident. I was in denial, and asked if she could see well enough by the night light to change her jammie pants. Duh. I forgot, somehow, that the bed would need to be changed as well and that moral support is required after an accident. So soon I was up changing the bed and getting Vivian settled. The second, obvious level of denial was that at 6:45 there was any hope of snuggling in and sleeping more.

And now Mazie was awake. She woke up smacking her mouth sleepily and yawning. I thought we had woken her, so I said, "It's okay, Mazie, you can go back to sleep" (note denial). She replied, "I know it's okay; I was having a GREAT dream!" Well! That's great! Sometimes I think their moods upon wakening are temperamentally determined and other times I think it's developmental. I think four is a difficult age for everyone. Both my kids have been more negative and more volatile at age four than at any other age. Five is liberating because, finally, their independence and capability are catching up to their intentions. But four is a doldrum year in our experience.

Basically, I returned to bed only to retrieve my bathrobe (I spread it over my side of the bed for extra warmth). The girls and I came downstairs because our neighbors, whom we love, sleep on the other side of a thin wall from the girls' room so that I'm pretty sure that every little bump from the girls' room translates directly to their eardrums. The girls brought down their dress-up arsenal and began playing "historical girl" while I booted up my laptop to start reviewing powerpoints. Also, I started a pot of half-caf. ("Half caf double decaf with a twist of lemon..." props to anyone who can call the movie that's from :).

First, historical girl. Mazie has been reading the American Girl series, the Little House books, and a different but similar series called "My America." Historical girl combines storylines from these three sources with certain favorite dress-up items. They repurposed their cook's hats as bonnets and they wear their dresses in confusing layers.

And studying. I have been through several permutations of trying to get the material as well and as efficiently as possible. We learn mostly from powerpoint slides and talks, so that's where the beef is, so to speak. I started out trying to honor the paperless goal of my school, but that failed immediately. Then I decided to take notes on paper in class, noting the slide number so I could use a combo of my written notes and the saved powerpoint file. FAIL. It didn't integrate things well and still relied on my learning mostly digitally. Next, I decided to use paper liberally because this is important, darn it. I commenced the longest-term studying solution so far: printing out slides before lecture, taking notes right on the paper printout, then having a hard copy to study from. The problem here... lots of font sizes or figures are too small to make the handouts practical. Plus, my hurried scrawling captured detail but made the finished product both visually and conceptually confusing (ppt provides little hierarchy of ideas). I decided what was lacking was logic and overview, which is still lacking in the printouts because they follow that exasperating ppt. format.

I have now gone all the way back to my tried-and-true study method of copying out notes longhand in outline form. The advantages: First, processing the concepts into a logical framework from which to build. Second, my own handwriting gives me some visual latitude to underline, star, all-caps, box, diagram, and arrow to my heart's content. Finally, taking the time to make a lovely handwritten study sheet is perhaps the best learning time I have as I mull over the concepts. The drawbacks: TIME (this may be fatal; we'll see) and my handwriting, which gets buck-wild with fatigue or caffeine or really anything less than an ideal situation.

Thanks for suffering that explanation. Booorrrrrinnnnggg; I know, but it occupies most of my waking hours, so it's important to me.

So, this morning. I outlined for as long as I could, inervening in disputes and, when "Historical Girl" had played itself out (largely because Vivian didn't know the story lines and kept wanting to do things the characters did not actually do), suggesting games other than "Let's play that I am the most beautiful fairy in the whole world." I exhorted them that beauty is subjective and ultimately disappointing. Yeah, they totally got it.

Then I played for a while (we made salt-rising bread and then stew), then made breakfast. Then Richie woke up (he's been getting less sleep than I have because he usually wakes up very early and can't get back to sleep)...and then I blogged. Now I am back to outlining....

I'm taking a study break

I have a date with the girls at 4:30 (that's 18 minutes ago, by this clock). They're late. They're out with Richie, taking video and getting a cookie. We're going to make Christmas cookies, decorate the Christmas tree, and listen to Christmas music until 6:30. Then it's back to the grindstone for me.

I have a test on Tuesday. It's the biggest test I've had in med school so far, covering four weeks and three anatomy dissections (one mine, two of the other teams') total. I'm nervous about it and I feel like my brain is swimming in info that is still sort of half-baked. I hope it rises and sets if I add equal parts "diligence and patience" (Dr. Churchward's encouragement phrase). This has been a difficult holiday, but not nearly as difficult as it could have been. It's difficult because I absolutely do not have time to do the holiday things I love doing or spend as much time with the girlies as I'd like. But it's less difficult than it could've been in the sense that I have gotten to read a chapter of The Best Christmas Pageant Ever to the girls each night and Richie is taking care of the rest.

This year Richie's making a Christmas website instead of us sending Christmas cards. That's why I haven't been posting photos; I'm saving them up so they'll be a surprise.

My fam is home, so it's off I go! And I actually showered just before sitting to type this, so I'm even clean.

Merry Christmas!

some pics

Here is one of the last opportunities to see Mazie with both top front baby teeth. She just lost her left one a week or so ago. She's very snaggly-toothed now, almost overnight. Just a month ago or so she had the perfect baby tooth smile (though she'd lost the bottom four already, it didn't seem to make much difference.). Now she has the top left blank space, the top right is crooked because it's on its way out, and the bottom far left is showing it's grownup tooth - but it's growing in sort of sideways. She's still so little; I guess she'll have to grow into her teeth.
Here we are at the corn maze. Richie took the picture. It was really fun. I felt addicted to finding the way. I was SO GLAD that the map was accurate. I was getting all ready for the map to be crazy, but it was really very good and made for a fun time.


So...Here's the most pitiful picture I have ever seen of Richie. Except one of him sleeping that Iwouldn't dare post. Of course, he's just coming off of general anesthesia in this one, so it's really not fair to post it. But he did take the photo himself (I was driving him home). He had just gotten two teeth extracted. Sad day. Here's one of the girls. They're wearing Skeledog tee-shirts. Our friends make them.

Halloween '09

Halloween was rainy but really fun. We trick-or-treated in our neighborhood. Mazie was a witch again - she loves the hat - and Vivian was a mermaid again, despite the outfit being size 2T. We tried to talk her out of it and suggested alternatives, but there's something so attractive about that costume that she would settle for nothing else. They carved the pumpkins (okay, Richie did the knife work but they drew the faces) at Nana and Poppy's house. And the baking hats are from Grandma and Grandpa and have been in steady use since we received them. We also have a freezer full of waning glow sticks. What better to put in your freezer?

I'm studying aging and dying this week. We have a lot of hands-on activities - competency workshops for screening older peoples' gate, balance, cognitive status, etc. It's a lot more interesting to me than I thought it would be. The module director is really good.

Richie is enjoying work. He got to design/draw a safety deck for a fuel delivery platform today. He was very excited. He has also gotten to do a fair amount of field work (measuring, photographing) so far.

Trip to Kennesaw battlefield...SuperFun

I knew this would happen.

I have no time to blog! I'm currently studying renal function. I'll have time to post photos and a little more content at some later date...TBD.

Best,
B

General update

We have an owl in our neighborhood that makes the wildest whooping sounds at night. I don't mean "whoo-whoo-whoo" but something else entirely more creative. I'll have to listen more closely next time it calls in the middle of the night so I can relate its sound here - I'm afraid I couldn't do it justice right now. It sounds a little like a monkey. Richie thinks it's a barred owl, but I'm not sure.

The girls are drawing with chalk on the sidewalk with their friend from three doors down, Ceja. Mazie stayed home today because we think she has H1N1 and Vivian hated having to go to school when she knew Mazie was staying home. Their school is going pretty well, although Mazie's class has just last week broken into reading groups even though school has been in for almost 6 weeks. Besides, all the reading groups are reading a book called, "Hop, Frog, Hop" or something equally beginner-level-sounding, and Mazie is - er - not being challenged. I have no idea what to do about that, but Richie and I are going for a conference with Ms. Johnson on the 22nd, during which I'll ask gently about challenging Mazie if her ability level is beyond the classwork.

Vivian goes into her pre-K every day with no fuss, according to Richie. It starts at 8:30, so I'm already in school by the time she goes in. Her pre-K is at a school for autistic children. 1/3 of her classmates are autistic. The teachers are highly trained, really energetic, and there are a lot of them. But I'm getting the idea that school for Vivian is 99% social - which is wonderful for kids with autism who really need help developing socially. Vivian's not complaining, either.

I still feel like I see a lot of them. I am able to keep the times that are ritually important - dinner and all meals on weekends. Bedtime. Church, most weekend outings, special events. But all the spaces between (the interstices) are full of school for me. The only movie I have watched in the past 2 months has been The Pink Panther in 2 installments. No T.V. because we don't have one. Basically, I'm busy and sometimes pretty brain-tired, but functioning like normal in the family, except that Richie has taken on 90% of my domestic responsibilities. I'm like a roving helper and he runs the show. (Thank you, Richie!)

And he's just putting chili on the table. :)

Explanation of pictures: Mazie and Vivian playing with giant balloons in the yard with our neighbor, Maria. Vivian and Mazie with storm troopers at a local parade. They were overwhelmed and a little worried; that's what their facial expressions are saying.

Okay, so we actually got H1N1

And it's rather old news now.

On Tuesday and Wednesday, I had two days of increasing cough - it felt almost painful. That "specialness" of the cough was the only warning sign that it could have been flu, but I honestly thought it was a cold because there was no fever (I know 1/3 of H1N1 cases have none...but still) and there were no other symptoms. By day 3, Thursday, I was feeling crummier than I had and was beginning the wild aches, so I got a reservation at student health. They were awesome; they put me in a room with other masked, puffy-eyed people and then they violated my nose. No, really, I adore student health and it was actually a very efficient visit with lots of good care from an NP named Molly who handed me tissues because I was still weeping from the flu test. She was one of those practitioners whose clinical presence I'd like to emulate. Anyway, I had a 101 fever at student health (no prior fever noted) and felt horrid the rest of that day. ( I was in denial about not being able to do my last-minute prequiz sprint, but I just...couldn't...think.) Then, Friday, I felt pretty lousy, but a little better. No fever control necessary. The past two days, I've felt modestly crummy, no body aches, cough resolving. No fever. Now I'm wondering, can I go back Monday morning? I am.

I'm feeling pretty badly about taking my germs into my grown-up school, but there's also the public health crime of the century that I've just committed: sending Vivian to school with the same cough for the entire week. Unlike me, Vivian never ran a fever (we checked), but I'm pretty sure she has what I have. I immediately kept her home as soon as I was diagnosed with H1N1 and that she probably has it, too, but she was at school for long enough to spread it to every child and teacher there.

Alas. I really didn't know :(. Sorry, everybody!

It's a miracle!

Vivian got better overnight and nobody else has gotten sick. YAY!

H1N1

Today my small group leader was on vacation (at Disney World!) and so we got to meet with Dr. Helinski. Dr. H is a pediatric infectious disease doctor. Naturally, the conversation flowed to its inevitable terminus: H1N1. Documented cases have increased rapidly (like, 5-fold) in the past week at one of the hospitals nearby, so we were discussing the ramifications of this early surge in Influenza A (H1N1 is technically an influenza A - just one we've no immunity for because of its porcine origin).

August is quite early for a surge in influenza. Usually the surge begins around November and cases begin to peter out by February. My question for Dr. H was, does this mean that this is the surge or could a second increase in infection rate be superimposed on this prior high infection rate, creating a super high infection rate in November. He said he didn't know but it's certainly possible.

Here are some other little things about Influenza A. They think this one will require two sequential vaccine shots to confer resistance. If the vaccine isn't ready until October and this Flu A is surging now, the vaccine will be too late to make a big difference. You have probably heard that this flu isn't particularly virulent, which is great. It does have the potential to mutate into something more virulent. If you get the current, milder form of this flu, the immune reaction you generate will protect you from even a mutated virulent strain. All this points to go ahead and get sick and don't worry about it.

However, the more human hosts the virus has, the more opportunities it has to mutate into something more virulent. So from a host-limiting perspective and from a population productivity perspective, it would be helpful for people to get the vaccine to stop the spread of the flu.

Those are just the things we discussed.

I will add that when we went to Vivian's ice cream social at her pre-K classroom on Friday, they informed us that one kid had gone home after throwing up and there were ominous rumblings of upset stomach from Vivian's best buddy, Beatrix. Beatrix looked positively peaked, draped on her mother's shoulder. Tonight Vivian complained of an upset stomach. Then, during sing and pray I noticed she felt warm. She had a 101 degree temperature. And now Mazie and I both feel a little queasy. Ohhhhh, boy....here we go!

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. :)