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Category: Medical School: Year 1

Year 1: That’s all folks!

When I thought to myself today, “Year 1 of medical school is done!” this familiar cartoon song immediately came to mind:

The Looney Tunes reference seems appropriate in more ways than one. Being in medical school certainly seems crazy at times. I had a successful career in publishing, and I’ve given that up to go back to the bottom of the professional ladder, to live on student loans in a dorm, to spend most of my recent hours at my desk studying and most of my future ones (for a time, at least) in the hospital. Why would anyone do that? Well, it could be that I belong in a Looney Tunes cartoon along with crazy Bugs Bunny and the bunch. Or it could be that I know this is exactly what I want to be doing with my life, and I’m willing to do whatever is necessary to make it happen. (I’m going with the latter, in case you were wondering.)

The cartoon reference also reminds me how important it is to laugh. This last year has been a challenging one. I’ve had to learn to study in a new way, to process more information than I ever thought possible. I’ve had to adjust to a new city far from my family and friends. That can take its toll. Remembering to have balance in my life — to eat well, to exercise, to spend time with people I love, to sleep in on the weekends, and to laugh — has kept me going.

Thanks to all of you who have helped keep me going this year. You are dear to me, and I love you very much.

And now, on to year 2 …

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Celebrate!

ChampagneI have two photos to share. First, the bottle of brut cava I just bought to put in my refrigerator for tomorrow. Not that I need an excuse to drink bubbly, but this is for a momentous occasion—to mark the end of my first year of medical school. I’m not quite there yet; I’ll be done in 24 hours. With all the hurdles I’ve have had to overcome to get here, finally finishing my first year—not only intact, but truly thriving—is surreal.

Rotation scheduleThe other photo, and another reason to celebrate: in February of 2017, I will begin my medical “clerkships.” This is where the rubber meets the road, so to speak. They send us out of the classroom and into the hospital to work with real patients (*gulp*). This photo is of my clerkships schedule, which I received yesterday. This will be my life, from February of 2017 to January of 2018: OB/GYN (6 weeks) → Primary care (6 weeks) → Psychiatry (6 weeks) → Surgery (8 weeks) → Anesthesiology (2 weeks) → Open elective time (2 weeks) → Neurology (4 weeks) → Internal Medicine (8 weeks) → Pediatrics (6 weeks).

Whew! So exciting. So much to learn. One day at a time …

Some memorable “firsts”

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.

You say “toe-may-toe,” I say “toe-mah-toe.” You say “satin,” I say …

You know you’re in medical school when …

You scroll past the band The Five Satins (who wrote “In the Still of the Night”in your iTunes list and think it says The Five STATINS. (For those not in medicine, statins are medications that aim to reduce cholesterol. Common statins include Lipitor and Crestor.)

And then in your head, you try to think of five different statins.

And by “you,” I mean “me.”

Oh boy. I’m not even through my first year …

Spring break: Just in time

Upenuf: It’s an apropos street name for the hilly roads surrounding San Francisco. It’s also an apropos phrase for my life. The months since starting medical school last August have felt very much like an uphill climb. Thankfully, just as I was muttering “upenuf” to myself, we got a week off for spring break. I headed to San Francisco to visit my middle sister, Sarah. What a magical few days! We visited a winery, hiked on the hilly paths of Pacifica, waded in the frigid ocean, walked among the redwoods of Muir Forest, and gazed up (and then down) at the Golden Gate Bridge. We also drank a fair amount of prosecco while eating goat cheese and crackers. I feel rested, relaxed, rejuvenated, and ready for the last push to finish my first year of medical school. Onward … and upward.

Here are more photos from my trip:

Look before you touch

Finding an element of humor in our medical school lectures is (1) entertaining, and (2) helps me pay attention. (Do what it takes, right?) Today, we started our GI (gastrointestinal) unit, and I was pleased to have a chuckle–at least to myself–within the first hour. The topic of the lecture was abdominal pain, which is one of the main reasons that gastroenterologists see patients both on an outpatient and inpatient basis. In describing the physical exam for abdominal pain, our lecturer talked about the importance of LOOKING before ever touching the patient. One thing he discussed was looking for surgical scars. Which sounds strange. And obvious. But apparently it’s not.

“The number of times the patient forgets they had surgery is insane,” he said. 

[Cue a minor chuckle.]

The physician went on to give a specific example of when this was important in his own practice of medicine. He recounted a time when he was called to the emergency room to evaluate a possible case of appendicitis. As he looked at the patient’s abdomen, what did he see? An appendectomy scar. So, not appendicitis, was his evaluation. 

[Cue a major chuckle.]

Lesson learned for the ER team, I would imagine. And for me, too.

You’ll either laugh or groan (well, maybe both)

Medical humor is something else. As a medical student, it’s something I’m exposed to on a daily basis. Let me emphasize that these jokes are not your typical stand-up humor. There are analogies and references that are quite specific, and sometimes off-color or even off-putting. It’s what you might call an acquired taste. Here are some examples.

The_Anatomy_LessonRembrandt’s facelift. You might be familiar with this famous painting, called the “Anatomy Lesson of Dr. Nicolaes Tulp.” Painted in 1632, it depicts the rare (for the 17th century) event of an autopsy. According to Wikipedia, these were social events with an admission fee. You’re likely not, however, familiar with the photoshopped version of the Rembrandt masterpiece, seen below:

IMG_0013

That’s right—instead of forceps holding up a muscle (or nerve), the tutor is holding an ultrasound transducer. This is Rembrandt for the 21st century, man! The image is a screenshot from a PowerPoint presentation on ultrasound we got earlier this semester from a radiologist.

Food for thought. The image below was from a presentation we got on “Special circulations and exercise” during our cardiology unit. Looking at the graph, I immediately grasped the concept—that food intake increased blood flow to the gut (for digestion). But WHAT THE HECK is a modified sham feeding?IMG_0010I looked it up. And according (again) to Wikipedia, it can take a couple forms. In animals, it often involves inserting a tube into the esophagus or stomach, therefore allowing anything that has been swallowed to leak out (and not be digested). Humans probably wouldn’t like that, though. So with people, here is what they do (this is still gross): you smell, taste, and chew the food, finally spitting it out rather than swallowing it. Now I know. And so do you.

IMG_0007To say the least. Also in our cardiology unit, there was a lecture on thrombosis—known more simply as clotting. Aspirin is something many people take to help prevent clots. But when you’ve got a big one already? Bad news. When this slide of a giant (and potentially fatal) clot came up on the big screen, I just had to jot down what the lecturer said: “At this point, aspirin is not going to help you.”

IMG_0688That’s just gross. We’re almost done with our pulmonology unit now. One thing we talked a lot about was pneumonia. Realize that pneumonia can be caused by a lot of different bugs. When a particular organism called Klebsiella pneumoniae causes pneumonia, the patient may hack up what’s called “currant jelly sputum”—bloody mucus. Don’t ask how I found this picture. But I did. Someone clearly has way too much time on their hands.

 

I Heart Ultrasound

apical view

This is an apical four-chamber view of the heart via ultrasound. Key: RV = right ventricle; TV = tricuspid valve; RA = right atrium; LV = left ventricle; AV = aortic valve; MV = mitral valve; LA = left atrium. Image from criticalecho.com.

Even though the focus of the first year of medical school is book-learning, we’re gradually acquiring hands-on skills like taking medical histories and performing a basic physical exam. This week, we got to try something different—cardiac ultrasound. Increasingly used for bedside diagnosis, ultrasound is seen by the Weill Cornell administration as an essential part of our education. It’s also pretty darn cool.

This past Tuesday afternoon, we broke into small groups and rotated through practice exam rooms where we met up with different faculty members and standardized patients. Each group member got a chance to obtain different views of the heart with the ultrasound transducer, including the parasternal long axis, parasternal short axis, apical four chamber, and subxiphoid views.

It was incredible to see the live heart in action, the muscle pumping and the valves fluttering before our eyes, after studying the organ in such great depth for four weeks. The machine we used was pretty nifty too. The screen was not much larger than an iPad. It was mounted standing up, with the ultrasound transducer attached via a cable. Knowing where to put the transducer on the patient’s chest wasn’t so hard—the difficult part was making incremental adjustments to center the image or angle the transducer to better see the chambers or valves. Like everything worthwhile, getting a quality ultrasound image will take practice. But this was a good start.

When it comes to what we’re learning, I like the science. I really do. But it’s clinical activities like this one that remind me of why I’m truly here.

Once a Reporter, Always a Reporter

pocket notebookFriends and colleagues from my former life as a journalist may recognize this notebook as the junior version of the spiral pads we used while employed at the Wednesday Journal, Inc. I discovered it while searching for a notebook that would fit in the pocket of my white coat. This fits the bill without running up the tab—$14.50 for a pack of 12 on Amazon.com. What is a medical history but a specific type of interview? So what better type of notebook to use than one made for a reporter? Just seeing it brings back lots of memories too …

Adventures in Medical School Cooking

celery root

Cooking with new ingredients brings about both successes and failures. Pictured here is a celery root. I got one of these from my local CSA recently and attempted to cook and mash it for dinner. It was … interesting.

Six months ago, if you’d told me that one thing I would do MORE of during medical school (compared to my previous life) was cook, I would have laughed in your face. Guffawed, actually. While I did a fair amount of cooking in my 20s, my early 30s was markedly stove free until I started using a meal preparation service during my last year in Chicago. You picked your meals for the week, and they did all the prep—the shopping, chopping, measuring—and then you cooked it at your leisure. It was magical. NYC has similar companies, but none that really had the freedom of choice that I wanted.

So when I first got here last August, I used my crockpot. Then when I got sick of that, I ate a lot of hummus. And a lot of chicken caesar from Just Salad, a restaurant down the street. I quickly realized hummus and eating out was not a long-term dietary solution. So the closest thing I made to a New Year’s Resolution this year was to do my best to be more healthy—that included regularly going to the gym and cooking too.

I’m proud to say both have been going well. It doesn’t hurt that I have a gym in my building. Or that I can get groceries delivered. Or that there’s an incredible CSA just across the street that provides me with a giant bag of produce each week for $12. Even so, it all takes effort, and time—the latter of which is in especially short supply for medical students.

It has been time well spent though, I think. And I’ve made some grand culinary discoveries. At this moment I’m eating kale. Before coming here, I had never once bought kale. I learned that I really, really like it. (Adding bacon, cranberries, and blue cheese doesn’t hurt.) Frisee is also amazing. And purple potatoes! But there have been failures too, as with anything. Like half of tonight’s meal, which went into the garbage after two bites (two because I thought maybe I was mistaken after one—I wasn’t). As wonderful as mashed (cooked) celery root sounded, it just wasn’t my thing. Not even grated parmesan cheese or fresh dill could rescue it for me.

It’s an adventure, though, and a break from studying—two things I gladly welcome each and every day.