Monday, May 26, 2014

The End of the First Year

As May fades away in the rearview mirror and we delve deeper into the first hints of summer, it’s hard to believe that the end of the first year of medical school has arrived. Much has happened in the past months. It seems as though we have learned more information in one academic year than many of us learned in most of our undergraduate experiences. We’ve been transformed from relative newcomers in the world of medicine to perhaps the most basic level of initiate – familiar enough to poke our way around and recognize a thing or two here and there, but with so much remaining incredibly foreign to us. We’ve been taught the basic skills of patient interviews and exams, and have gone from bumbling around in our standardized patient sessions (what do you do with this otoscope? Or is it an ophthalmoscope...?) to being able to perform relatively fluid interviews and make our way through a rudimentary exam (although, really, we’re still bumbling around – perhaps just in a slightly more polished fashion). Finally, my wife gave birth to our son almost four weeks ago – a busy addition to an already busy life, but a more than welcome one. We’re happy to have him here.

We’ve learned so much that sometimes it’s easy to think that we have come far in our medical education. And, to be sure, we have – but by no means as far as we might like to think. I was reminded of this once again while recently shadowing my third year student preceptor while he was rotating on pediatrics. While listening in on their table rounds, I was able to pick up on certain little things here and there (hey, beta-2 microglobulin? I know what that is!), but most of it flew far above my head. But while I don’t understand most of the finer points of what was being discussed, or at least only understand certain things on a rudimentary level, I found it incredible to watch how the providing team took all of these random minutia (most of which I hadn’t learned, some of which I had but was surprised to see show up in such a practical way) and fit the seemingly-unrelated pieces together to construct a coherent diagnosis and treatment plan. It was simultaneously daunting (we have to learn all this stuff?) and encouraging (it will be pretty cool to be able to do that…) to watch their finely-tuned performance.

Though I’m frequently reminded of how far I have yet to go, sometimes we get the opportunity to flex our “clinical muscles,” so to speak, and practice what we’ve learned – which is always a satisfying experience. One of the ways I was able to do this was while shadowing my physician preceptor, an internal medicine/pediatrics physician, at her clinic. There, I was able to interview several patients, including one who came in concerned that she had been feeling down for a while. She put on a brave face for the first few minutes of our interview, but when we began delving deeper into what was going on her life, she broke down into tears. My first instinct was to reach out and comfort her in some way, but I had to stop myself – this wasn’t a loved one, but rather a patient, and it probably wouldn’t help her much to have some random medical student wrap her in a bear hug. Still, though, I tried as best as I could to talk through things with her and encourage her. After I finished the interview, I presented her case to my preceptor and she came in and arranged further follow up with the patient. It was encouraging to see the patient leave with at least some hope for the future and a definitive plan in place to take care of her.

I also had the opportunity to volunteer at some of the different free clinics around the greater Chicago area. With a multitude of patients to be seen and oftentimes only one, maybe two, attending physicians present, it’s a place where bright-eyed medical students can actually, sort of, kind of be somewhat useful. Or at least we’d like to think so. In any case, it does give us the opportunity to take our interviewing and examination out of the safe walls of our clinical skills center and into the world of real medicine.  One patient in particular that I remember came in complaining of pain and swelling to his right lower leg over the past two weeks. He had a vague history of surgery to the area around six years ago or so in a different country, though he wasn’t sure what the procedure was or what it had been for. He’d now quit work because it was too painful to stand, and thus didn’t have insurance. I had the opportunity to interview him and perform an exam, noting things like pitting edema, good pulses, calf tenderness, and a distended area in his popliteal fossa that was tender to the touch. From some prior experience working in an emergency department, I was concerned that one possible cause for his symptoms might be a deep venous thrombosis. After leaving the patient’s room, I presented the case to the sole attending that was there, and after examining the patient he was also concerned that that might be the case, and started the process to get the gentlemen the care that he needed. While the role I played was small, it was still satisfying to have reached a point where I at least could recognize that something wasn’t right and build a case, using different points of evidence from the history and exam, to support what I thought was going on.

So it’s been a busy year. Even though we’ve been done for almost a week, it took me a few days to realize that it was all over and I really, actually, honestly didn’t have any more material to study. I remember thinking over Christmas that it was cool to be halfway done with our first year, but then I would remember that it was only an eighth of the way through the entire thing. It’s nice to be able to say we’re now a quarter of the way done, and half of the way through the bulk of the classroom stuff. This summer, I’ve got a clinical research project lined up that shouldn’t consume too much time, at least after a couple of semi-busy weeks, which will leave me free to hang out with my wife and our new son. We’re all looking forward to it.
P.S. I’ve been receiving more questions about how I use Anki. I’ll probably be doing a Anki Q&A: Part 2 sometime in the near future (the first one can be found here). That said, feel free to send me any questions you’d like to see addressed, either via email ( or the comment section below. 

Thursday, May 1, 2014

Our Little Human

It’s been a while since I’ve written a post. We’ve been going at breakneck speed through all of the organ systems in our physiology class, and just when I was starting to get a handle on that pace, we started immunology as well. Also, as I’m writing this, my newborn son is sleeping quietly next to me in his hospital bassinet. So yeah. Life has been busy.

Since starting with the cardiovascular system, we’ve slogged through respiratory physiology, the renal system (bleh), gastrointestinal physiology, metabolism, nutrition, endocrine physiology, and now we are just about to start our reproduction block (how’s that for timing...).

Image politely stolen from here

So far, school has continued to go pretty well. Physiology has been, for the most part, an enjoyable class. It’s not like there is a ton of practical medicine contained within those hallowed PowerPoint slides, but you’ve got to start somewhere and it’s definitely more applicable than something like the molecular biology and genetics course we started out with. Immunology has also been surprisingly interesting. It’s one of those classes where getting the big picture is essential, but once you’ve got that down things start falling into place and making a lot more sense. Also, we’ve got less than a month left in our first year of medical school, which is awesome.

But the most exciting development in the past few weeks has been the arrival of our son. He was actually a little late, going by estimated dates and whatnot, since he finally rolled into town at 41 weeks. We actually thought he might come at least a couple of weeks sooner – my long-suffering wife had started feeling nauseous, really tired, and having more frequent Braxton-Hicks. Anecdotally, those things sometimes point towards impending labor, which was exciting. Of course, the weekend that she started feeling these things was the weekend before an extremely front-loaded test week, so we were crossing our fingers (or at least I was) that we’d be able to make it past at least two of the three exams we had that week before our son decided to arrive.

Make it past the tests we did. We also made it through the rest of the week, and the next weekend, and the rest of next week, and… you get the idea. Be careful what you wish for and all that, I suppose.

Finally, last Friday, we had another routine appointment at the hospital. My wife was a little bit dilated, which was exciting. Afterwards, they wanted my wife to have a non-stress test, just to assess fetal health since she was a couple of days past 40 weeks. The test involves her belly being hooked up to devices that measure the fetal heart rate and indicate whether or not she is having a contraction. Just like when we stand up or something and our heart rate increases a bit to compensate for it, when a baby is turning circles in his mother’s womb his heart rate should also go up. The test is basically looking for that to happen a certain number of times within 20-30 minutes. It’s a pretty basic screening test, though – if it’s “reactive,” or if the heart rate increases like it’s supposed to, then everything’s usually fine. If it’s “non-reactive,” though, or the test says that it didn’t pick up the heart rate changes, it’s actually wrong a little over half of the time.

Our test on Friday, of course, was non-reactive. It didn’t help that the nurse we had, while nice, was obviously new and wasn’t really doing much to inspire any confidence. We knew things were probably fine (my wife could feel him moving around quite a bit), but as a follow-up test they do something called a biophysical profile – basically an ultrasound where they measure various criteria and assign the baby a score that describes fetal health – the higher the better. Our son got the highest score possible, which was reassuring. That said, it turned into an unexpected four-hour hospital visit.

The doctors at the hospital wanted us to come back in on Saturday for another non-stress test, just to make sure things were fine. That one was fairly quick and painless, which was good. We had a fairly relaxing day on Sunday (with lots of walks! Walking is one of those things that is supposed to speed things along, so we spent a lot of time walking in the last couple of weeks).

On Monday, we had another follow-up appointment at the hospital. Everything was still looking good, but my wife hadn’t really progressed much since Friday. Which was fine, except having a large child inside of her belly was quickly getting really old, really fast. She spent most of Monday doing everything she could to get things going (massage, acupuncture, walking, various positional changes, etc.). Finally, Tuesday morning, she felt like her water might have started leaking. She really honestly wasn’t sure and otherwise felt fine (and we found out later it was really a pretty small leak), so she and her mother (who had flown in a few days earlier) went to the hospital to get checked on, honestly expecting to be sent back home. Since we thought that she would likely end up coming back home, and I had an exam that day at school, I went in that morning but kept my phone close. Before I got a chance to take the exam, though, they called and said it was in fact her water that had started to break. Finally!

I grabbed my stuff and headed out the door. For whatever reason, today of all days was one of the darkest, stormiest days we had had for a while. To get to the hospital, I was driving into the heart of the gloomiest-looking thunderstorm I had ever seen. Which was fine, except that when I got there it was raining cats and dogs and by the time I made it from my car to my wife’s car in the parking lot (to grab some bags) to the hospital, I looked like I had decided to take a noon-time swim in my dress shirt and slacks (we had dressed up for standardized patient interviews that day).

Originally, we wanted to stay at home as long as we could before going into the hospital, but since she had tested positive for Group B Strep (a type of bacteria that different people normally colonize at different rates – about 1 in 4 women or so are positive, but it can be very harmful to a baby that is exposed to it during the birthing process), she needed to come in a bit earlier to get antibiotics, which is really the only reason she called and came in when she did. Also, she really wasn’t having super strong contractions yet – they were still pretty basic Braxton-Hicks that she had been having all along. But again, since she was GBS positive, she really needed to start having contractions soon after her water broke. Since she wasn’t, they started her on a low dose of Pitocin (a synthetic form of oxytocin, the hormone that – among other things – causes uterine contractions during labor). She labored like a champ for eight or nine hours on the Pitocin drip (which is somewhat infamous for sometimes causing contractions that can be much more intense than those that you might have normally), and finally had an epidural late that night, which allowed all of us to relax a little bit and actually dose off for a few minutes at a time here and there. Finally, at almost 6 am the next morning, our son was born, weighing a healthy 7 lb 14 oz.

As I sit here now and watch him sleep (which is really something I should be doing as well, since sleep has been a rare commodity over the past day and a half and things don’t look to get any better any time soon), it’s almost surreal to realize that he is our child. It’s really incredible to realize that this temporarily peaceful little human belongs to you and is your responsibility. It’s something that is hard to grasp from just interacting with other people’s babies or young children – this little guy is yours, and it’s your job to keep him alive and teach him about life and all that that entails. It’s also incredible how darn cute and little he is, but I digress. Things will be busy, I’m sure, particularly with medical school in the mix, but I wouldn’t have it any other way.