Some memorable “firsts”

by Lorien E. Menhennett

This past week, I had a couple of memorable medical school “firsts”:

  • First heart murmur. We’ve just started our Physical Diagnosis module, and this means we’re going to the ACTUAL hospital to see ACTUAL sick people—not actors who are pretending to be ill. Each week, we have to take a patient’s medical history, do a basic physical exam, and then report our findings to our physician preceptor. Our group of four medical students was back in one of the patient’s rooms, where our preceptor was asking a few additional questions. He leaned down to listen to the patient’s heart. When he discovered a murmur, he waved us over to listen for ourselves. I stood there with my stethoscope on the patient’s chest, half expecting to hear nothing. I’ve been in situations before where a doctor has found a murmur, and I’ve listened, but not heard a thing. This time was different—the normal “lub-dub” heart sounds were replaced by a sustained “whoosh.” I know it will take a lot more time, and hearing a lot more hearts, before I can be confident of what I hear. But this was a good start, and a signal of progress—I’m starting to be able to tell “abnormal” from “normal.”
  • This image (which I found online) shows exactly what we did - use an ultrasound machine to place a needle in the internal jugular vein.

    This image (which I found online) shows exactly what we did—use an ultrasound probe to place a needle in the internal jugular vein of a mannequin.

    First ultrasound-guided line. Ok, so this was done on a mannequin and not a real person. We’re obviously not there yet. But it was great experience to practice using an ultrasound machine on the mannequin’s neck to find the internal jugular vein, and then continue to use the machine to place a long needle in the vein (without piercing the adjacent artery or other structures). In real life, you would then place a catheter (hollow tube) in the puncture site. You might use this access point to administer medications that can’t be taken by mouth.

This first year, we spend most of our time in class or studying things we learned in class. For me, getting a taste of practical medicine has been a little terrifying at times, but also thrilling.