"You'll never see this again in your career," the anatomy prof warned us.
This week's anatomy lab, our last, was a particularly unsettling one for me.
Even though we have done a number of dissections of every part of the body, most of them have retained the semblance of normal anatomy - while we've dissected the entire abdomen and thorax and arms and legs, we haven't removed limbs or anything.
So when the anatomy professors showed us an incredible way to visualize the neck components from the back of the mouth to visualize the epiglottis, trachea, larynx, and then demonstrated the technique, I had a bit of trouble watching.
That's because the dissection technique, shown to us by the anatomy instructor on the demonstration cadaver, involved dissecting through the back of the neck... to the point where the heads of our cadavers were rolled forward and almost entirely removed from the bodies.
It was true - the technique provide a fantastic way to understand the anatomy, and I learned a lot from it.
But seeing a person's body with the head nearly removed, even though I have seen them dissected in every other region, was just a bit much. I was reminded again about how these "specimens" are actually human beings who at one point cared about us and our future patients enough to donate their bodies to our anatomy program.
I don't get the chance to thank the people our cadavers once were, and sometimes I wish I could. But because I can't, I decided to post a speech I gave at the memorial service our school held for the families of the body donors...a tribute of gratefulness, in memoriam.
My name is Vitum Medicinus, and I'm a representative of the second-year medical class. I've been asked to welcome you here and to convey the feelings, experiences and, most of all, the appreciation of the students who have the incredible privilege of learning anatomy in the best way possible thanks to the incredible gift your loved ones have given us, through the anatomy program at our medical school.
This ceremony is a unique one. Many memorial services focus on celebrating the life of the individual being remembered. In that sense, this service is no different.
But this one is unique in that it is much more than that - it is a service of admiration and gratitude, in memoriam of those who have given so much of themselves, and in doing so, have taught us so much about the intricacies of science, using so few words.
Every student in these faculties would tell you that no textbook could ever equip us to understand and aid our patients in the way the donors have. The anatomy program is an educational privilege that none of us could ever take for granted.
And yet, beyond the lessons of science, through their actions the donors have taught us many more lessons.
For example, they have taught us about bravery. Thinking ahead to one's own final moments is not always a comfortable thing to do.
And they have taught us about selflessness and altruism. They have given as much of themselves as they could, to ensure that we, as tomorrow’s health care practitioners, will have the best possible preparation for tending to those who need our help.
Through their generosity, the donors have indeed set a high standard for us, in demonstrating the qualities that we future dentists, doctors, and therapists, should all hold dear when we treat of our future patients.
And so we thank them, and wish we could share with them, tell them how much we appreciate their decision.
While they have taught us so much with so few words, it would take all the words in the world for us to begin to show them our thankfulness, which is what we will try to begin to do today.
The students you see here have put together this service in its entirety in an effort to show our respect and appreciation, and in memoriam of the contributions of these generous individuals.
All parts of this service - the candlelight procession, readings and musical performances, are dedicated to the memory of those whom we have come to pay our respects and gratitude to today.
Friday, February 22, 2008
This memorial service is unique in that it is so much more.
Tuesday, February 05, 2008
"The chemotherapy hasn't helped yet, but I can beat this."
In yet another assignment to hone my interviewing skills, I found myself on a hospital ward this week asking a charming patient about her medical conditions. Though it wasn't what had brought her to the hospital this time around, I soon found out this fairly young lady was battling pancreatic cancer, and could no longer work due to the severity of her condition.
"I come in twice a week for my chemotherapy. It hasn't really helped yet, but I don't think I've been on it long enough for it to start curing the tumor," she said, fidgeting with the Natural Cures for Cancer book on her lap. "I'm pretty optimistic that I can beat this."
I was inspired by the patient's courage. Given her dismal condition, it was nice to see there was a ray of hope promised by the treatment.
Before I presented the patient's story to my preceptor, I obtained some collateral information from the chart as I had been asked. From what I read there, however, any ray of my hope in my mind quickly dimmed.
I'd had a feeling during the interview that something wasn't quite right. While I'm not a doctor yet, let alone an oncologist, I do know that pancreatic cancer is pretty serious. But, I had taken her on her word that there was an encouraging outlook. Perhaps her type of pancreatic cancer responds well to chemo, I thought.
What I found in her chart confirmed my initial suspicions:
"Patient has Stage IV advanced pancreatic adenocarcinoma, receiving palliative chemotherapy."
Though palliative chemotherapy can help with the pain and other symptoms of cancer, it's not provided with the intention of "curing the tumor."
Maybe nobody ever fully explained to her the role of palliative chemotherapy. Worse yet - heaven forbid - maybe she hadn't even been told that her therapy was palliative.
But the situation probably wasn't either of those. Because right after that, the physician had written,
"Patient is in denial with regards to her condition, despite numerous discussions regarding prognosis."
When I discussed the case with the doctor, he explained it to me another way. "Barring a miracle, the flowers in her room will last longer than she will."
I still wonder if I should've gone back to her room to say goodbye.
Sunday, January 27, 2008
How To Clean your Brain, as told to me by a schizophrenic patient
Shortly after I decided to go into medicine, I knew the day would come when I would have to deal with a branch of medicine that both fascinates and intimidates me: psychiatry.
I'm not sure what it is about dealing with psychiatric patients that makes me so nervous. Perhaps it's how much I value my own cognitive abilities. Maybe it's the stories I've heard of patients in acute psychotic episodes, throwing furniture and yelling obscenities. Or it could be that every psychiatric ward I've ever been to or seen in movies sends chills down my spine.
But now that I've started my Clinical Skills unit on interviewing psychiatric patients, my naivety has resulted in a few surprises. I was blown away when I interviewed someone who has a severe form of a psychiatric condition, yet could still carry on a coherent conversation. I was also quite stunned after the patient told me about their ability to carry on conversations with squirrels in the park and according to their chart had to be tied down in four-point restraints on admission to the hospital, yet answered a number of Mental Status Exam questions testing insight, judgment and thought process as any normal person would.
Of course, the psychiatrist training us told us that there are a few exceptions to this.
For example, some patients will speak in what is termed Word Salad (ie. "I was running down the sidewalk, over the alleys in the supermarket. Sometimes the store is full of nuns, and sometimes the airplanes fly lower. But when I was younger, they threw me over the furnace and the time was singing."), and another patient he remembers didn't speak a single word in the interview, later revealing that he did so because he thought the psychiatrist could read his thoughts.
The patient I interviewed was a bit shy at the start but completely warmed up to me after a little bit. I was a bit nervous when the patient listed off their favourite weapons, stood up to demonstrate self-defence fighting techniques with intense enthusiasm, and then looked at me with hollow, peircing eyes and shouted "I'M GOING TO F------ KILL YOU!" (fortunately while recounting a conversation with somebody else, but it was still pretty intimidating!).
After getting a bit of history from the patient, I looked through the interviewing handbook we'd been given, and asked a couple questions from the "Anxiety" and "Depression" categories, but didn't get very far. Then I picked a question from the "Psychotic" category: "Do you have any abilities that other people don't?" and the patient lit up like a Christmas tree.
"Oh, definitely. I can clean out my brain."
"Really?" I replied, trying hard to stay professional and not crack a smile.
"Oh, yeah, I do it all the time."
"Could you tell me how you go about doing that?" I inquired.
"Sure, all you have to do is fill up the inside of your skull with water. Let it fill up slowly - not high enough that you'd drown, but close to the top." The patient held up hands to demonstrate the appropriate depth. "Then, all you do is shake it around a bit" - again I was given a demonstration of proper procedure - "and after that let it drain out, all through your nose and drool it through your mouth, all the way out until it reaches your navel."
After the interivew, I mentioned to the preceptor that I was stunned that given a demonstration like that, the patient could still answer a number of simple Mental Status Exam questions testing insight, judgement and comprehension correctly. "That's normal for someone with this disorder," said the psychiatrist. "Some of my patients with schizophrenia are incredibly high-functioning - they carry on normal lives with successful jobs - accounting, engineering for example." I wonder how many are doctors.
So that was my first psychiatric patient. I'll get to watch other students in my small group interview a number of other patients over this unit, and hopefully see a variety of pschiatric conditions. For me, however, after a few weeks' exposure to psychiatry, I've concluded that to me, psychiatry is a speciality just like pathology. While I'd never want to become a pathologist given the stigma, I have to admit that the more I learn about it, the more fascinated I am by it.
Sunday, January 13, 2008
How a doctor might tell you that "you are dying."
Which is worse... telling a patient directly "you are going to die," or having them leave your office having no idea because you tried to phrase it gently?
While I haven't yet been trained in breaking bad news to patients, the answer to this seems like it may be fairly obvious.
In an article published in the Journal of Clinical Oncology, author Scott Berry tackles this issue. Most interesting is a role-play situation in which physicians had to tell a patient they were dying; only one of eight oncologists used the word death. In the name of empathy and gentleness, perhaps the following statements veered too far into the realm of vague:
What the physicain said: Most people with this disease will have problems soon...Time could be very short—a few weeks to a few months. I think it is advisable to prepare for the worst and hope for the best.
What the physician meant: You are dying.
What the physicain said: Your time may be short.
What the physician meant: You are dying.
What the physicain said: If there were a hundred people in your situation, most of those people would have major problems within one month or so...let's consider that we are now at Labor Day. By the time we get to late September, early October, I would expect that you would be having major challenges or problems.
What the physician meant: You are dying.
What the physicain said: Certainly, it sounds like the disease is really threatening your life.
What the physician meant: You are dying.
Friday, January 11, 2008
Rite of passage (or, Delicious Irony)
Every medical student comes to a point in their career where they must perform their first digital rectal exam (DRE).
Today, during a clinic rotation, was my turn.
In a delicious twist of irony that I think was lost on my preceptor, another physician in the office was having a going-away party which we visited directly after this little procedure.
In other words, within minutes of performing my first DRE I was celebrating my new-found skill with a slice of...
...wait for it...
...chocolate cake.
