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.

The Stare of Death

I’ve been on fall break for the past week…and it’s been glorious. Loyola starts a little early, but that translates into a week-long break halfway through the first semester. Which is most excellent – and much needed. It’s been a long few months. My wife and I have spent the break basically trying to be as non-productive as possible (i.e. watching a ton of old movies that we watched as kids, eating ice cream, and occasionally doing more big-person things like shopping, home repairs, etc.). We’ve had a blast.

We also got to go to our first ultrasound, which was awesome. My wife is twelve weeks along now, and he?/she? is starting to look like a little human being. It was quite the moment when we got to see our child moving around, kicking, and generally looking cute on the ultrasound screen. Just because I can’t resist, here’s one of the pictures we were given to take home with (awww....). His/her feet kind of look like claws in this view, actually. But they’re really quite normal – we checked. I may or may not have tried to count his/her fingers.

But, alas, break is soon going to be over, and back to the grind we go. We started anatomy a few weeks ago. It’s actually been really interesting, but it’s also been really, really busy. The tried-and-true fire hose analogy that people use to describe the volume of information coming down the pipe at you in medical school – all of which you have to know, and know well – continues to be proven true, if not even more so than before.

Loyola actually recently changed up their anatomy curriculum. Their overall goal was to cut down on required time slogging through excess adipose tissue in the lab and increase the time that students had to master the material on their own. Personally, I’m a fan of that goal. Dissection is an awesome experience, and somewhat of a rite of passage for doctors-in-training, but it can nevertheless be somewhat of a drain on one’s limited amount of time. So, instead of having close to twenty bodies for the class and everyone in the lab at once with only a few instructors to go around, they’ve cut the body number down to six, posted a faculty member at each table, and split the class up into rotations, with each rotation dissecting a certain region of the body. I was assigned to the thorax and abdomen, which should be interesting. Students can, by the way, go down whenever they want, but only absolutely have to be there during their rotation. Additionally, instead of making us sit in lecture, they’ve tried to summarize the key points of lectures in short-ish videos that we’re supposed to watch before coming to class (which, during anatomy, only goes for about an hour or two max – which has been awesome). During class, the idea was that we’d go over board-style questions that made us really think through the relevant material to arrive at an answer.

There have been a few glitches in the execution of their new curriculum, however. The biggest issue has been with the videos and “lectures.” Unfortunately, trying to pare down anatomy to a few “key points” leaves a lot missing. It’s difficult to then go forth and memorize crap when we really don’t know where to stop – we could, of course, go on memorizing forever (and, being the neurotic medical students that we all are, we would). We really didn’t know where to stop. Additionally, we were supposed to watch these videos the “night before” the “questions lecture,” which really gives us no time to process and learn the information…which means that the lectures really turned into a waste of time, since we had no idea what we were supposed to be doing. Finally, some people weren’t happy about the change in lab setup – I remember one of the questions that always seemed to come up in tours of the schools on interview day was something along the lines of “What’s your student-to-body ratio?” (As an aside…this really isn’t all that important. Really.)

Thankfully, Loyola is pretty responsive to its students. We had a Dean’s forum, where we basically were given free food and were able to ask the Dean of the school any questions that we had. Anatomy was a hot topic. We all expressed some of the above concerns, and within a few days we started to see some changes. First, the “question lectures” became more “lecture-ish.” This was actually the most helpful change, in my opinion, as it’s nice to have someone walk you through certain things that don’t come as easily from a short video or staring at a textbook. Next, the professor produced a more definite list of what we should focus on. Finally, for those students who wanted more lab time, the professor started doing short, daily reviews in the lab of the previous day’s dissection, just so we can see things on an actual human body instead of simply in pictures and to save us the pain of going down on our own and trying to pick through things. So far, I think things are shaping up for the better – we’ll see how things go.

I have had a few opportunities to get out of the classroom, though. One of the things I did was volunteer at a free clinic in Chicago that Loyola students basically take over for one night a week. First year medical students essentially observe, might take a history, and pretend to listen to heart and lung sounds. Second year medical students, on the other hand, really get to run the show – they’ll interview the patient, examine them, come up with a plan of treatment, present the case to an attending, talk it through with them, and write a note. It’s really a great opportunity to get out of class and use some of the skills we are learning. So far, first years have only covered the patient interview and spent some time interviewing standardized patients, but as the year progresses we’ll learn more physical exam skills. That should be fun, and the clinic should be a great place to practice and take a break from class.

Loyola’s anesthesiology interest group also has a program called APEP, or Anesthesiology Preceptorship Enrichment Program. It’s essentially a program that pairs students up with an anesthesiologist mentor with whom they meet once a month for a few hours during the anesthesiologist’s shift and discuss some basic science concepts in the operating room. It’s a great way to translate some of our bookwork to the real world. I’ve met with my preceptor once so far, and had a great time. We talked about different sedation methods, intubation, difficult airways – and there was mention of a possible opportunity to intubate in the near future. That’d be fun. The program isn’t just for students interested in anesthesiology. I personally didn’t have a huge interest in it coming in to medical school, but I do want to explore different specialties and see what’s out there. Also, it’s a great opportunity to spend some time in the hospital and learn some practical stuff that one might not get through a lecture.

Finally, I was able to spend an afternoon shadowing an emergency physician. Since I worked for a few years in or around an emergency department before medical school, and this is the specialty I have had the most exposure to, it’s also the specialty I’m most interested in at this point (supposedly, I’m supposed to change my mind about this at least twelve-bazillion times in the first couple years. Or so I’m told. I’m sure I probably will). It was a good shift – it’s different being introduced as a medical student and getting the opportunity to participate more in the patient’s care. As a scribe, I was used to standing in the corner and writing down what was going on. Now, I actually get play some small role, and that’s a lot of fun.

About halfway through the shift, we heard the EMS radio come on. Through the static, we gathered that there was a full code about to come through the door. The usual calm before the storm ensued – people began to prepare one of the trauma rooms and gather around the stretcher, double-checking their equipment and wrestling their uncooperative gloves onto their hands. Then the double doors to the ED flew open and a stretcher came through. It was being guided by two people with another person trying their best to continue chest compressions while walking alongside the stretcher. I didn’t catch most of the story, although it didn’t sound like there was much of one – male in his mid-sixties, found down. CPR started at the scene, epinephrine given just outside the ED doors, no response.

The doctor I was shadowing didn’t have this patient, but followed the stretcher into the room to see if the other doctor on wanted a hand. My scribe instincts kicked in, and I started to look for a corner to stand in and stay out of the way. Before I found one, though, she motioned me to follow her in and threw me a pair of gloves. The poor soul who had walked in beside the stretcher doing compressions had been relieved by fourth year medical student who was rotating through the ED, but he was starting to look a bit fatigued. Before I knew it, I was standing over a very dead-looking patient, bouncing up and down on his chest, and trying to keep time to “Stayin’Alive” in my head.

This was my first time doing CPR on a real person. The first thing that struck me was how everything seemed to slow down a bit. There was plenty of time to think. The second thing that struck me was how grey the fellow looked. After that, I was surprised by how “rubbery” his chest felt – somehow, I didn’t expect the rib cage to have that much rebound. Finally, I quickly started thinking that I really should do more cardio – compressions are exhausting!

The doctors did a great job of making it a teaching experience. They showed me and the other students where to check for a pulse to make sure that the compressions are effective, and after using ultrasound to check for cardiac activity, walked us through what they were looking for and what showed up on the ultrasound. It was really interesting. They also made sure I saw the “fixed and dilated pupils” – the stare of death. That was…weird. It really was a truly empty gaze. With cadavers, their eyes are usually closed. It was different staring into the eyes of a person who, moments ago, might have been thinking about what they were going to eat for dinner that night.

The gentleman didn’t make it. Or, more correctly, he stayed dead. And life went on. We went and saw another patient, the body was prepared for viewing, and…that was it. I had seen people die before, but this was the first time I had really been involved in their care. That said, it really wasn’t sad so much as it was more of a profound moment. I wonder if that feeling will stick around.

Medical school continues to be a blast. This week off has been awesome, and I wish that it didn’t end in a couple of days, but at least the material we are learning is, I think, really interesting and fairly relevant to our future careers. So, back to the grind we go.

Paradigm Shifts, Puppy Therapy, and Pregnancy

Well, I’m about a month and a half into medical school

It’s been a hectic month and a half.

Last Monday, we had two tests, one of which was a final for the Behavioral Medicine and Development class (BD). The other was the second of three midterms for Molecular Cell Biology and Genetics (MCBG) class. It’s nice to have BD over, and we have one week left of MCGB before anatomy starts. I’m looking forward to it, actually – MCBG has essentially been an intense undergraduate course with a clinical application here and there. While interesting, once we start anatomy I’ll feel like we’re actually getting somewhere. Oh, and after the tests, the school brought in some dogs for the students to pet – “puppy therapy,” they called it. As funny as it seemed, it actually was a bit therapeutic to spend some time with one of the labs!

Before starting medical school, I heard some medical students comment about the paradigm shift that often occurs once you start. In undergrad, those of us who are now in medical school were all neurotic type A folks (ok, that hasn’t changed) who were generally at the top of our class. I don’t say that to boast – we had to be. We had something to prove. Now, though, we’re all together in one room. That means that many of us who used to be at the top are now… average. That’s not a bad thing. It would be an honor to be even in the lower echelons of a class full of people as intelligent and dedicated as my classmates. It’s just different.

I for, one, am still regularly impressed by the quality of my classmates. These people are smart. It’s not infrequently that I get the sneaking sensation that I’m not supposed to be here; that I’m an imposter of sorts. The rate at which these people can acquire and regurgitate large volumes of information, seemingly without effort, never ceases to impress. I’ve generally never been one who could simply hear something once and retain it forever – I need to work at it. Hard. That translates into hours spent studying just to try and stay caught up in things like small group sessions. Of course, I’m sure my classmates are putting in some daunting legwork themselves, but if they are, most of them seem no worse for the wear. Ah well.

On that note, Anki has continued to be a great tool for me. I need that regular, daily repetition to really make things sink in. I wish I would have used it, at least to some extent, in undergrad. I would have retained a heck of a lot more. Its efficacy cannot be overstated, at least in my case.

What to Expect When You’re Expecting

Now for the more interesting news – we found out during the first week of medical school that my wife is pregnant! We’re both very excited, and looking forward to next spring.

When my wife told me that she was pregnant, my first reaction was one of complete excitement. That was quickly followed by a reaction similar to Gary Cooper’s in the film What to Expect When You’re Expecting (not out loud, though!):

After that, though, I felt a very profound sense of… responsibility, I suppose. We are going to raise a child. That is pretty incredible.

Of course, this has been a less-than-optimal time to go through the genetics component of MCBG, where we are learning about all of the chromosomal bad things that can happen to a developing child. They are rare events, of course, but still! It was nice to finish that section of the course.

We both continue to eagerly look forward to a healthy pregnancy and, hopefully, a smooth delivery. My poor wife has had to put up with a busy husband and some pretty nasty nausea. Hopefully that will get a bit better here in a few weeks as she gets through her first trimester. In the meantime.Zofran is awesome.