"She was dying, and he didn't even look at her."

"I was watching my wife die over the course of those nine months. Our family doctor sent us to see a specialist. Without even doing a physical to see the her ribs jutting out of her back, he told me that 'women typically lose weight during their menstural period.' I was shocked. She was dying, she was as skinny as a corpse, her brain wasn't functioning properly, and he tried to tell me it was her menstrual period. He didn't even look at her."

That happened almost thirty years ago, and still, my patient's husband talks as if this happened last week. Today I had to go to the home of a patient who had volunteered to discuss their chronic condition, part of a rather interesting assignment meant to get me thinking about the impact of a chronic condition on a patient's life and family.

Unfortunately, the husband is still convinced that the only reason his wife was eventually diagnosed or received treatment is because he reamed out the doctor.

Not every story like that has a happy ending. But this one did. Once they diagnosed the disease, although that was a nine-month process, they gave her one injection and other than the low body weight, she was completely normal the next day. Today, one pill per day is all she needs to live a completely normal life, and if she didn't tell you about her disorder, you wouldn't even know it existed.

If only all diseases had outcomes like that...

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"Um, is this your first time examining a woman there?" "Hell no!"

I gave in.

I know I said I was going to sit out the Maternity Hands-On night, but I didn't go just for the vaginal exams (and what if I did, anyways? I'm going to be a doctor, I need to get experience, nothing weird about that? right? why do I feel as though I have to justify this?) I went for two reasons: 1. I was there anyways for a meeting of the Emergency Medicine club, and 2. free pizza!

I'm glad I went, too. Not only did I get elected to a position in the ER club, but this was probably one of my most practical and interesting events since starting med school. Hopefully it's a taste of things to come in January when we stop the cirruculum of undergrad review and get into the doctory stuff.

I delivered a baby, determined how dilated a woman's cervix was, and felt for the position of a baby inside a woman's stomach!

Had I known the first two of those would be on fake silicone models, I wouldn't have been so shy about attending. Mind you, I was clearly not the only shy one. Even though there was a great turnout - almost a quarter of our class showed up - the men in the group were far fewer in number.

It was interesting, too, learning how much an experienced physician can tell from an exam; how the baby is lying / presenting, etc. Someday I'll be that good - someday at the end of my OB/GYN rotation, and it will probably all go downhill from there.

And the best part? If a woman ever asks me while I'm conducting the above procedures, "Is this the first time you've ever done this?", I can emphatically and truthfully say, "Hell, no!"

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The P=MD discussion, furthered

Before leaving the states, I wondered at all the rumors I heard coming from the Caribbean. Do they study on the beach? Do their professors sip cocktails with little umbrellas in them during the exams? Are they really learning medicine in a Third World Country?
Yes, the rumors were true.

That's a direct quote from the Rumours Were True blog. If I can't come up with anything interesting to post, why not post a reciprocal courtesy link to someone else? Especially if I apparently had something to do with their posts! In case that intro isn't interesting enough, Topher of RWT was kind enough to further a discussion I initiated about pass/fail medical school marking.

Judging by the apparent popularity of this discussion, perhaps I'll muse about PBL (Problem-Based Learning or Case-Based Learning) here sometime in the near future.

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Extraeducational Patient Encounter

I felt like a real doctor today for a brief moment.

When I was switching buses on my daily commute home, I saw someone waiting for the bus whom I recognized - a woman who had been a patient of mine!

Okay, I'm not a doctor yet. Not even close. And in actuality, all my "patients" to date are either cadavers or fake - hired actors.

The one I fortuitously saw on the street today fell into the latter category, in case you were wondering.

Even though my feeling as though I am a doctor lasted for less than a measurable time quantity, it was kindof neat. I know that happens to doctors all the time, running into patients of theirs. My friend's dad is a GP in a small town, and it happens to him. It must be nice for doctors having these little reminders that they've made a difference in somebody's life, every time they bump into them. Or perhaps they're more like reminders of what a nightmare the patient was and how stressful the doctor's practice is.

Maybe I'm just stretching for ways to feel like I'm becoming a real doctor, since I don't get that feeling very much in class. All our classes so far are a repeat of fairly simple concepts we learned in undergrad, or even worse, high school. I've learned how cells divide about six or seven hundred times already, and that meiosis happens in the somatic cells and mitosis in the germ cells (don't freak out, I'm on it, that was a little joke for you science people out there). It seems like it's going to be like this for the rest of the first term, too, since it's designed to catch up the people who, unlike myself, do not come from a science background.

There's just enough new information that I have decided to heed the words of pretty much any second year I've talked to: "Don't get behind! Stay on top of the material." So my days of little to no homework are gone; I've started making work for myself, namely, reading and studying the notes, so that when study time for our midterm comes up in a few weeks I won't feel too pressured. But still, that midterm's only worth 5% of our grade...so how much pressure can that be?

That being said, you can probably understand how it's a relief to study things that are more clinically related, like our small group session on hypertension today. Though the second half of the first-year curriculum promises to be a lot more work, my friends in second year say it's a lot more clinically relevant and a lot more interesting. I think I'd rather have lots of interesting work to do than be bored reviewing things I've already gone over.

I have a feeling that I'm going to regret saying that someday.

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Did we mess up? Our cadaver's heart is on the RIGHT...

"Now that we've gotten past the superficial muscles, you're going to start seeing differences from one cadaver to the next," said our anatomy prof.

Boy was he right!!

Some of the crazy / cool stuff we've seen already:

• Situs inversus with dextrocardia

This is a rare condition in which the person's heart was on the RIGHT hand side of their body, and all of their internal organs were reversed! (Liver on the left, spleen on the right, etc.) You gotta see it to believe it. Our anatomy profs hadn't seen this one in person before and they were so excited they were freaking out.

• Pulmonary Atrophy

One of the cadavers had a left lung that was very tiny, and the right lung was MASSIVE

• Pacemakers

Right after cutting back the skin of the chest, a few of the cadavers had stainless steel pacemaker implants

• Sutured sternum

Those individuals who had cardiac surgery have their sternum sliced down the middle; following the surgery, the surgeon uses stainless steel sutures to bring the sternum halves back together.

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