Wednesday, October 31, 2012

Careers in Medicine

Wife and I have talked a ton of times about our reasons for choosing our respective careers. For those new readers out there, Wife is in a BSN (Bachelor's of Science in Nursing) RN (Registered Nurse) program, and I'm in my first year of an MD (Doctor of Medicine) program. The discussions usually stems from how glad one of us is (usually how glad she is, since I'm not quite to the "doing-what-I-signed-up-for" point yet) with what we chose to do with our lives. The thing is, a lot of people struggle with which area they should go into in health care.

The bottom line is that the majority of people go into health care because they want to help people on a fundamental level. Sure, there are a few that might only be going into it for job security or the money, but I'd bet they're a small minority because there are many, many much easier and less time-consuming ways to make money and have a steady job. So the motivation really isn't an issue.

The next step with most people after realizing that they want to do something in health care is figuring out what they'd like to do. There are unit techs, phlebotomists, nurse's aids, radiology techs, licensed practicing nurses (LPNs), registered nurses with/without BSNs, nurse practitioners with/without PhDs, physician assistants (PAs), and doctors (MDs and DOs) - and a million others that I'm not taking the time to think up right now. This is a daunting list of options for someone who wants to go into healthcare. It only gets slightly less crazy once a decision has been made - especially if that decision involves being a nurse or doctor. More on that in a minute.

When Wife was at this point and was considering a career in Nursing, I encouraged her to shadow some nurses to see what she thought of the whole thing. That went swimmingly, and she enrolled a few short months later. She now has only about a year and a couple months left before she hits the real world as a nurse, and she is being forced (okay, not really forced - she's so smart and dedicated that she's been pursuing the idea of higher education in Nursing at very little prompting from anyone else) to consider whether or not she wants to continue her education at a Master's or PhD level.

Here's the thing: Wife is meant to be a nurse of some sort. A lot of people think that if you want to go into medicine and you're smart enough, you become a doctor. That's ridiculous. Not every smart person is meant to be a doctor. She's smart enough that she could do literally whatever she'd like to do. She's brilliant, truly. But when it comes down to it, there are things she wants to do, and there are things she doesn't want to do. She's been asked multiple times, "So why don't you want to go to med school?" She always replies with some variation of, "I'm just not one of those people - but thank goodness those people exist!" That's actually her refrain when she sees me in the middle of a marathon of studying - "I'm so glad there are people like you in the world..." Then she makes me a sandwich.

You see, she likes taking care of people, but wouldn't so much get a kick out of the years of hard science and sleep deprivation that go with training in an MD or DO program. That, plus she wouldn't want to sacrifice the one-on-one time spent with patients that nurses get and doctors all too often are forced to miss out on. Plus, there's no reason to say she won't continue her education at a higher level after a year or two in the field. There's no telling where we're going to be once I'm in residency, but even if there isn't a local graduate program in Nursing around, there are still quality programs through MSN online that offer a wide variety of options.

So Wife chose nursing because that's the best fit for her, personally. And apparently I chose the route of physician because I love studying for years and years and years the application of hard science to bettering the health and well-being of others. Even though we've chosen our careers, by no means are our choices done. I still need to end up picking a specialty, though Emergency Medicine is looking more and more like a good pick for me, as I go through endless seminars on the myriad of specialty options. Wife has the slight advantage of being able to move from one area to another as a nurse. Once I pick a specialty, it's a lot more difficult to change my mind... So I don't plan on doing that.

So keep all this in mind if you're thinking about a career in medicine or health care in general. There's a right fit for each individual, and it doesn't always have as much to do with intelligence as with motivation, personal goals, and style. This is actually a really good thing, as every single position in the field of health care is absolutely vital. Without one part of the pyramid, it all comes crumbling down.

Monday, October 29, 2012

Getting Pumped for the Abdomen

The semester feels like it's flying by.

Does that really say the next Anatomy lab exam is 11/12/12?
And that's only two weeks away???
Last week we had our Biochemistry final exam on Monday (hooray for being done with Biochem for FOREVER until I have to start studying for Step I!), lab and lecture exams on the Upper Limb (all structures in shoulder, upper arm, forearm, and wrist/hand) on Wednesday, and a Physiology / Histology exam on epithelium and nervous tissues this morning. I've been keeping my head above water so far, so that's good!

Since Biochem is over, we started Genetics last week, and our first quiz is tomorrow morning. Like the rest of my class, I'm a little behind in Genetics... A lot behind, honestly. At least I don't feel alone in that, right? 

Today in Anatomy lab, we're starting the Abdomen! We started Abdomen in lecture last week, but today is our first time spent working on it in lab. I don't know why, but I've sort of been looking forward to this all semester. The abdomen is where most of the organs are that do stuff in ways that keep the body running. Yeah, there are a few outlying structures that do things - and they're very interesting too, it's just... I don't know. I don't mean to put down the brain, lungs, heart, limbs, and skin (hopefully they're not offended), but there's just so much going on in the abdomen! It's like a whole greek salad of organs, and I can't wait to get in there and see which component is my favorite.

Too graphic? Perhaps, but it's my blog. Just know that the eating metaphor is just that - a metaphor. Anyway, I have tons of stuff that I could dump into this post, but I actually do have to prelab and study for Genetics, so in the words of one of my more socially adept classmates...

Later yo.

Tuesday, October 23, 2012

To Become a Healer

I've been reading for almost an hour now, after finishing my last blog-vomit post about how packed my day has been. And now, it seems so trivial to have been focusing on how "packed" the day of a med student can sometimes be. Like I said, I've been reading the required readings for my "Introduction to the Patient-Physician Relationship" class. Some of the readings (seven total) were nothing new, but some were refreshing and engaging!

My favorites were these:

Yale Medical School Graduation Address 2010 by Donald M. Berwick, MD, MPP

Discovering the 'Heart of Care' by Frank D. Gabrin, DO

18 Stethoscopes, 1 Heart Murmur and Many Missed Connections by Madeline Drexler

When I first sat down to read, not knowing what the readings were about, I remember actively thinking to myself, "This is so a waste of my time right now. I should be sleeping. Or studying Anatomy."

I had to force myself to read, much as you might have to force yourself. After I started reading these three articles, though, I had to force myself to stop reading just so I could blow my nose or rub my bleary eyes. I was engaged. I was hooked. I was reading things that really brought me back to the reason that I want to be a medical student doctor.

These articles were worth my time, even as exhausted and crusty-eyed and snot-nosed as I am at 1:00am after an 18-hour day. I'd highly recommend reading them, even if you're not interested in becoming a doctor. Do you know someone who is a doctor or healthcare worker? Do you have a doctor that you visit with any regularity? If you want a glimpse into their life, if you want to know a little of what it means (or should mean) to be a doctor, then read these articles. They probably won't change your life, they probably won't transport you to another realm of comprehension of and unity with your physician - but I guarantee you won't regret reading.

As I read these stories, I couldn't help but have images flash through my mind of the various (and relatively limited) experiences I've had in healthcare so far. From wheeling patients through the emergency room corridors as a volunteer, to asking the nurses if there was anything I could help them do, to helping a doctor insert a catheter on an elderly woman with dementia, to speaking with the wife of a heart attack patient, to my simulated patient interviews and the distinct reversal of roles I've only just begun to experience, I find myself realizing that I really want to be the kind of doctor that Madeline Drexler said that the medical student Ben was destined to become.

One of my fellow classmates said something to me a couple of weeks ago, and I'm still not quite sure what spurred the comment. We were in Anatomy lab, and as we we were working on something, identifying several objectives on a body, a couple of other students came over to ask us a question. I ended up going over to show them where the structure was on their body. When I got back, the student I had been working with said, "Justin, I think you're going to become a great doctor - maybe even one of the greatest." Caught completely off guard, I couldn't think of anything to say other than to chuckle, "Heheh... Why do you say that??" She replied, "Because you actually care about people."

I want to be that kind of doctor. The kind that helps other people stay positive if at all possible, and that helps them through when it's not. I want to be the kind of doctor whose intrinsic nature inspires trust in his patients. As Dr. Gabrin would put it, I want to not only cure, I want to care. I want to be one of the doctors whose figurative forehead-mounted neon sign flashes, "I care." In short, yes, I want to become a doctor - but even more so, I want to become a healer.


My days this week are packed. Today was a blur: Biochemistry final this morning (it's a half-semester fitting two semesters' worth of material). Good news - I passed both the final and the class, so no need to remediate! Hooray! After the exam was over, I studied Anatomy for a couple hours, skipping a genetics lecture (I streamed it later) in the process.

After an hour-long required lecture introducing us to our newly-themed clinical skills class format, I studied another hour of Anatomy, then did my officially graded, simulated patient interview. Basically, it was the fourth (and final, hence the "graded") simulated patient interview of the semester. So, I got dressed up in nice clothes and a tie and my white coat and interviewed an actor posing as a patient. I think I did well on that, though I don't think I get my final grade until the end of the week, as a grader needs to sit down and watch my 12.5 minute interview to grade me.

After that, I spent 2.5 hours in the Anatomy lab, drilling everything I could about the muscles of the upper limb into my head. After that, it was an hour of Bible study, then another three hours in Anatomy lab working on getting the nerves and arteries of the upper limb straight (or anastomosed?) in my head. After that I went home and streamed that Genetics lecture and studied Anatomy for another hour. All told, today was a solid 16 hours of studying, exam-taking, and lecture-attending.

Right now, I'm exhausted. I'm not feeling down, but I am feeling sick. My sinus infection hasn't completely gone away, though it has spread itself into my respiratory tract, so I've got a pleasantly hacking cough to go with the pounding sinuses. Hours upon hours of bending over cadavers tends to result in headaches, so I'm keeping the acetaminophen handy. Overall though, my spirits are generally pretty high, despite the high workload, stress, and ill health.

Right now, it's time to sleep, and am I ever going to need my rest for tomorrow. Somehow, CHM thought it would be a good idea to schedule me for SEVEN HOURS IN A ROW OF LECTURE WITHOUT A BREAK. That's right - from 8am till 3pm, I'm scheduled to be in lectures with no break longer than you might need to go to the bathroom. That means no lunch. Luckily, there are two hours of lecture in there that I can skip and stream later, so guess I'll be doing that. And sometimes the faculty wonders why students don't attend all the lectures. Sometimes, it's because their schedule looks like this:

Now, this wouldn't be such a big deal if we didn't have an Anatomy final on Wednesday. That's really all I want to be studying for right now, so all of these side things feel really distracting. Also, that last green block for tomorrow is not optional, like it might seem. It's required. And I just remembered that today they notified us of some required readings that we have to do for that. Which I haven't done yet... Shoot. What time is it? 12:01am?

Guess I'd better get started.

Monday, October 15, 2012

A Weekend in the Life of an M1

This weekend was full of studying, minus Friday. I must agree with Wife, Friday was great. As for Saturday and Sunday, I finally got close to caught up with reviewing lecture notes; I'm only six lectures behind on Phys now. To those of you that don't know how I roll when I'm catching up on weekends, I shall enlighten thee:

I watch lectures. I take notes in the coursepack. I share my notes online with my med school class, just in case anyone missed a lecture or a blank. I then go back through every page of every lecture's notes, creating digital flashcards using Mental Case, just like when I studied for the MCAT. I then share all of those flashcards online with my class as well.

The thing is, this process tends to break down when I'm preparing for exams. I tend to get just a tad behind - like when preparing for this last set of Biochem and Anatomy exams, I didn't go back through any Physiology lecture notes. Nor did I go back through any of the newer material for Biochem or Anatomy that wasn't going to be covered on the exams.

Granted, it could be worse. Some students not only don't go over the new stuff when preparing for exams, they don't go to lectures at all. I know a lot of people spent this week streaming lectures like mad trying to catch up. I'm sure that'll happen to me at some point, but so far I'm treading water in that area.

So, I went through something like 160 pages of lecture notes to create 318 flashcards in Anatomy and Biochemistry. I didn't quite get to Physiology, but that's what tomorrow night is for... That, and the other four hours of lecture that we'll get in 7.5 hours from now.

Oh, the roaring life of an M1...

Tuesday, October 9, 2012

Moose on the Highway - A Med School Analogy

Image credit:

So Monday was our second Medical Biochemistry exam - way more difficult than the first one. I actually had a joking conversation with some fellow med students where we weighted the pros and cons about which would be more preferable - taking a Biochem exam or getting punched by a drunk. The good news is that I studied way harder for this recent exam than I did for the first one and ended up with a grade I can be proud of. Unfortunately, that was not the biggest moose on the highway this week. That classification belongs to the Anatomy Head and Neck exam, which comes in two parts. I'll be taking the lecture exam tomorrow morning at 8:00am sharp, followed by the lab exam at noon. The volume of information in this unit is absolutely staggering.

It's actually that very volume that is going to cut this post shorter than I'd like, as I have to get back to work. To give you some sort of idea, I can tell you that it covers the material from page 637 to 969 in our coursepack - 332 pages of fairly dense material. Here's one stereotypical page:

This material translated into 585 flashcards, most of which have multiple "sides," as they're all digital. In fact, here's a screenshot of my computer from just before I decided to write this post:

That's right. If you're observant, you noticed that I've been studying in the Secchia Center for over twelve hours now, and probably won't be able to go home for another two or three still. And I still won't have covered everything we "need" to know for tomorrow. I spent about six hours in the lab before sitting down to churn through the lecture material.

And such is the life of an M1. I know I have readers who are in the pre-med stage. If you like studying, this is for you. Especially if you like exams, too. I love the learning and the studying, but it's the exams (and the horrible stress they bring with them when they're only 32 or 45 questions covering hundreds of pages of material) that really get me. Give me med school without exams, and you've got one happy Justin. The good thing is, I didn't sign up (or get accepted) to be a med student. I'll get through this, just like all of my classmates.

Wife called me earlier this evening saying she was on the road, dropping off a surprise for me back at my apartment here in Grand Rapids. She's been on vacation (Fall Break - can you IMAGINE?!?) for the past two days, so (even though I know she's had a huge amount of work to catch up on) she decided to bring me a surprise. How awesome is SHE?? So I have that to look forward to when I go home, at least...

All right, time to review the branches of the subclavian and external carotid arteries... Wish me luck in avoiding tomorrow's moose!

Image credit:

Sunday, October 7, 2012

Punched by a Drunk

Tonight as Wife and I left the med school after a marathon study session (well, 12 hours... not really a marathon, but definitely not a short day), we noticed an individual staggering toward us across a bridge near where we'd parked our car. He was very obviously drunk. Very drunk. I've never seen someone that drunk and still able to walk at all. For the sake of this story, I'll just refer to him as Drunk Tim.

As he staggered across the road toward us, I got a closer look at him. He was wearing a Northface fleece jacket, nice jeans, and had on some shiny black shoes. He looked well-to-do. After he staggered across the road to where we were, we had a conversation that went like this:

Me: "Hey, are you doing ok?"

Drunk Tim: Hiccup. "-Yeahwhy?"

Me: "You seem really drunk... Where are you coming from?"

At this point, Drunk Tim staggers into me and almost falls over, so I help ease him to the concrete with his back to the wall. I asked again:

Me: "Where are you coming from?"

Drunk Tim: "Thatway," gesturing in the direction he'd come. Let me just say, I have no clue where he'd come from. There weren't any bars for almost a mile in that direction.

Me: "Where are you headed?"

Drunk Tim: "Thatway," gesturing in the direction he'd been going.

Me: "Were you going home?"

Drunk Tim: "No, thatway."

Me, chuckling a little: "Were you having a good time tonight?"

Drunk Tim: "Always."

Me: "What is your name?"

Drunk Tim: "Can't tella that..."

Me: "All right. Can you tell me your address? I want to call a cab to take you home, or you're going to get hit by a car, stumbling around like that."

No response. At this point I'd like to mention that Drunk Tim is hiccuping so much, I'm just waiting for him to spew ten gallons of beer all over himself. I was making sure I stayed strategically at his side the whole time. As we spoke, I had Wife go put our stuff in the car. No sense hanging out on the street corner trying to help someone with thousands of dollars of laptops just lying around in our backpacks.

I tried again:

Me: "Do you have a wallet? I want to get your address so we can call you a cab."

Drunk Tim: "Yeah."

Me: "Can you get your wallet out?"

Drunk Tim: "Yeah." He makes absolutely no move to take his wallet out.

Me: "All right, please reach into your pocket and take out your wallet so I can see your address, ok?"

Drunk Tim complies, though it literally takes him about five minutes of fumbling to remove his wallet. When I see his address, I start entering it into my phone to get an idea of how far out of town he is. His address is for a completely different city that I don't even recognize. As my phone is looking up directions to his address, I try to make some small talk.

Me: "How old are you, Drunk Tim?" I'd seen his driver's license, so now I knew his name was Drunk Tim.

Drunk Tim: "Older than you!"

Me: "Hahaha, you think so?" I didn't think so; he seemed a couple years younger than me, perhaps. "Tell me how old you are and we'll find out."

Drunk Tim, his brain completely befuddled by the amount of water-soluble ethanol in which it was drenched, misunderstands me. He seems to think my lighthearted banter about relative ages is a serious affront: "Oh yeah, you - hiccup - youwanna GO?!" That's right, he is actually hiccuping while picking a fight with me. He clumsily lunges for his wallet, mumbling angry nonsense under his breath, so I hastily give him his wallet back and jump to my feet.

Somehow, he manages to get his wallet in his pocket and lunge at me with much more coordination than before. I jump out of the way, and he staggers wildly, falling against the building for support. Before I can do much, he charges at me again, this time hitting me in the face as I tried to dodge out of the way. The thing is, Drunk Tim is so drunk that he doesn't even really make a solid fist. Combine that with the fact that he only connected with a glancing blow, and all he really succeeded in doing was knocking my glasses half off my face before I grabbed him by the shoulders, stuck a foot in front of his legs, and pulled him forward, tripping him to the ground. I felt like I was fighting a child, and who hits a child throwing a tantrum? Regardless, my heart was thumping like crazy. This is nuts, I though. What the heck is he doing??

I caught my glasses before they could fall to the ground, and shouted out to Wife (who was still down the street a short distance, putting our stuff away at the car), "Wife! Call the police!" I found out later, she never called the police. She ran toward me and by the time she caught up to us, Drunk Tim was walking out into the middle of traffic and I was following from a long distance, dialing 911 on my own phone.

Drunk Tim proceeded to walk right across the road in the middle of traffic, cars swerving wildly to miss him. I still can't believe nobody hit him. As I stood on the corner of the street across from where Drunk Tim ended up, describing our location to the dispatcher (it took a million rings for anyone to answer...), Drunk Tim suddenly charged across the street toward us, yelling obscenities and stumbling all over the place. I yelled to Wife, "Wife! Run!"

Wife was a little shell-shocked at this point, and I don't think it quite registered that I was telling her to run. Why? Because she stood there. And didn't move. "WIFE - RUN!!!" Wife suddenly whipped out the running skills and took off down the road. In the opposite direction from me. Before I could turn around and follow her, Drunk Tim was between us. I made sure he was following me, then stayed just ahead of him as he slosh-ran after me, screaming his crazy head off. The whole time, I'm giving the dispatcher a play-by-play run of events while she asks me if I'm safe.

End of the story: Drunk Tim stopped chasing me once he ran into a mailbox. He ended up sitting on the street corner throwing his shoes and screaming obscenities at no one in particular (except a couple choice words directed at Wife) until the police showed up and took my statement before arresting him. At one point, as I gave my statement to one officer, Wife  heard the other officer as he grilled Drunk Tim say, "Why would you do that, man? He was just trying to help you out. And it looks like he could've taken you, anyway."

At the end of the night, I learned to just call the police when you see someone so drunk they don't even know their address. And Wife learned that when I yell to call the police (or, "RUN!"), you call the police (or run) -  without stopping to think about it. We're safe, and Drunk Tim never got hit by a car, so that's what counts.

Monday, October 1, 2012

Phys Exam #2 - Check!

Views like this are one reason why I actually enjoy studying late at med school. I don't know what I'd do without the awesome views, both in the day and night.
Seriously, how awesome is it do see this every evening??

Today marked the start of our second round of exams with Physiology #2. If you don't know, most of our exams are on Mondays (except for those that are on Fridays... yeah.) so that we can have the weekend to cram prepare effectively. So, that's what most of us did to get ready for today's exam. Except for the occasional outlier ("Which of the following factors is NOT Vitamin K-dependent? A. Factor II. B. Factor XII. C. Factor VII. D. Factor X.  E. Factor V." Excuse me? We were specifically told by our professor - and I'm quoting - "Do NOT worry about individual factors. Just know the basics of the clotting pathways - that there is an intrinsic pathway and an extrinsic pathway, and that they are BOTH necessary for the common clotting pathway."), the exam was pretty much what I hoped for. It was the kind of exam that they could have made really hard or really easy, and I think they put it just a little on the hard side of "middle," which I'm ok with. This is, after all, medical school. Stuff's hard.

Now, it's back to the worlds of Biochemistry and Anatomy. While I'm caught up on lectures, I feel behind in reviewing said lectures. The professors tell us to not to switch our focus from one class to another based on when the exams are, but I honestly don't know of another way to do it. How do you not focus on Physiology when the exam is three or four days away and you know the Anatomy and Biochem exams are more than a week off? The only way I can think of to not do that is to quit sleeping, which I'm not quite willing to do - yet. We'll see what happens after round two of Biochem and Anatomy a week from now...

Right now we're doing Head and Neck in Anatomy, and it is a doozy of a unit in terms of volume and specificity. I had no clue we had so many muscles in the neck, and the number of nerves and vessels puts the number of muscles to shame. To SHAME. We get these packets of objectives in the "Directed Study Group" (mine is three hours long every Monday night) that show lists of objectives like this:

The Head & Neck packet has six pages of those objectives that we need to know and be able to identify on cadavers. I'm not complaining at all (I actually really like memorizing where everything is and thinking about what muscles are moving someone's mouth when they're yawning or sneezing or grimacing), I'm just stating some facts so you can get an idea of what this is like for med students. When I think about how every doctor that I've ever met or heard about has gone through this process, I feel my intrinsic respect for them increase dramatically.

So the next time you go to the emergency room or visit your doctor and he/she is hurried or frazzled or maybe shows his/her imperfection humanity in some other way, think about everything they went through to get to that point. Most doctors really do deserve our respect for what they've done with their lives, and that respect isn't always evident when we get bothered when we have to wait, or if a doctor makes a mistake.

All right, I've spent longer on this than I'd planned, and now it's time to prelab for this afternoon's Anatomy lab: "Eye and orbital contents, Ear." Wish me luck.

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