Do not try to satisfy your vanity by teaching a great many things.
Awaken people's curiosity. It is enough to open minds; do not overload them.
Put there just a spark. If there is some good flammable stuff, it will catch fire.
-Antole France, Nobel Laureate in Literature
My mom and I were talking the other day about the extreme skill of people who can synthesize lots of information and break it down into just what's important and just what you can remember. It came up because we had been talking about translation and culture in my Medical Student Leadership Group and I told them about an experience I had with translation over break:
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One of my mom's friends who is a Somali refugee had just had double bypass surgery in the hospital. Bypass surgery involves having at least one, but sometimes more of the major arteries that provide blood to the heart replaced, in this case with a vein from his arm, which is very atypical. Usually a vein from the leg is used because you have so many more of them) only to discover a few days after his discharge that he was almost seizing in pain. He returned to the hospital to learn that he had fluid building up in his pericardium (the sac of tissue that surrounds the heart and keeps it separate from the rest of the contents of your abdomen), which he had to have drained over the course of a few days in the hospital. He was then discharged again with a list of nine medications to take.
And here is the real problem: the discharge paper wrote the medicines as their brand names, whereas the pharmacy gave him the generics. I'm not sure if the pharmacy explained it to him but I know he didn't understand and they gave him no written material with any explanation of which drugs are which and which to take for which. When I got to his house, his son (who speaks and reads more english than his father) showed me the sheet that he had created from what he heard the doctors say the medications were for. We googled the medications to find out what they were - but we still weren't sure which were important for keeping him from having another heart attack and which were for discomfort (one of the medications he was prescribed was zolpidem, which is an anti-anxiety medication that is used to make you sleep).
So we called the cardiologist on call (a different one)and asked him which medications were absolutely vital and could he please tell us the generic names of them. He immediately said three medications were absolutely vital (in the true sense of the word), but the others were more flexible. There were even a few that he only needed to take if he was in lots of pain (oxycodone) or couldn't sleep (zolpidem) or had heart burn (omaprazole). When we explained to the doctor that he had an incomplete grasp of the english language, the doctor totally got it and just broke it down into the most basic (and like he said, most vital) components.
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When talking to my mom, we were recounting the best teachers, doctors, lawyers we knew and how all of them shared the quality of not giving people information to look more knowledgable but in a way where they knew it was being absorbed. I used to think that professors that simplified things were less expert, but in medical school my favorite professor yet spent an entire class talking with us about a bathtub metephor he had for homostasis, the ability of the body to re-balance itself after being thrown out of whack.
Plus, I like the part in the quote about a spark.
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"I could teach a monkey calculus - you just have to find a way of relating it to something someone cares about. For example, so you like the WWF, right?..."
-my favorite quote about education, from the movie Road Trip
January 9, 2010
December 26, 2009
Christmas and A Break from Anatomy (sort of)
Yesterday was Christmas and six days since I last had to focus on anatomy - yet, I find myself thinking about it constantly. One relative showed me his ventral hernia - where his intestines poke through his abdominal muscles, which were cut and never healed from a previous operation, so that you can feel the intestines right under his skin. And I think of all the ways a hernia can be defined: direct, indirect, complete, incomplete.
Another relative talked to me about her struggle with the side effects of her antidepressant medication (weight gain, high blood pressure, nausea) and how she was weighing them against the symptoms of her depression. I think of what I'm learning about how your stomach has even more receptors for seretonin than your brain.
A friend pointed to the part of her knee that hurts her when she runs and even though I don't know anything about pathology yet, I could tell her that it was her patellar tendon and it was an extension of the muscle that runs down the front of her leg and makes up her quadriceps.
I explained the differences between the different types of tonsils and how you only call your pharyngeal tonsils adenoids if they're inflamed. I talked to my sister about how mono works and why they would be so worried about ones spleen bursting.
I find myself having moments where I just sit still and feel so lucky that everything in my body is somehow managing to work correctly.
Another relative talked to me about her struggle with the side effects of her antidepressant medication (weight gain, high blood pressure, nausea) and how she was weighing them against the symptoms of her depression. I think of what I'm learning about how your stomach has even more receptors for seretonin than your brain.
A friend pointed to the part of her knee that hurts her when she runs and even though I don't know anything about pathology yet, I could tell her that it was her patellar tendon and it was an extension of the muscle that runs down the front of her leg and makes up her quadriceps.
I explained the differences between the different types of tonsils and how you only call your pharyngeal tonsils adenoids if they're inflamed. I talked to my sister about how mono works and why they would be so worried about ones spleen bursting.
I find myself having moments where I just sit still and feel so lucky that everything in my body is somehow managing to work correctly.
December 10, 2009
An Afternoon in the ER
A few weeks ago I shadowed an incredible physician in the ER for an afternoon. I had planned on going for a few hours after class and ended up staying for half of a shift (= 6 hours) because it was fascinating.
For background, I had actually never thought about becoming an ER physician until I started interviewing for medical school. I had been of the opinion that I would be personally frustrated by stabilizing and not treating patients. However my interview at the medical school I currently attend was with an ER physician and I just loved hearing him talk about his work. The biggest thing that struck me was that he said, I am the very last type of physician who says, I will try to help no matter what; no matter who you are, what you have (or don't), if you have insurance, if you speak english, if you live here or are just visiting - I will try to help. And while I think that speaks to the flaws of our medical system, it's also true.
So I arrive in the ER around 2 pm with my stethoscope and lots of questions. Over the course of the time we saw so many patients that there isn't space to recount them all, so I'll just pick two.
The first was a man who came in an ambulance having grand mal seizures and potentially a heart attack. It was the first case where I got to see the ER respond. It was almost like a dance; the physician I shadowed prepared to create an airway down this man's throat, the nurses set up all sorts of medication stations, the charge nurse (the head nurse) coordinated with the paramedics so that when they arrived, they knew exactly which room to come into and what to expect. They cut off his clothes, hooked him up to monitors for his heart, breathing, and blood pressure. Then the physician started talking to him, in between seizures, to check to see if he could be responsive. He grabbed her hand and dug his nails in hard. They got him hooked up to oxygen, made sure there was nothing for him to hit, and started to give him medications to help break his seizure.
The second was an older man who came in with his brother. He was incredibly thin and pale and his brother was scared because he had not wanted to get out of bed that morning or eat anything. The physician I was shadowing asked them about their history and found out that the patient was terminally ill and had spoken with a hospice care worker with whom he (and his brother) had decided that he would be comfortable at home. His brother, it seemed, was rethinking that decision as the patient was getting closer and closer to actually dying. The physician explained what hospice care was and asked the patient if he still wanted to do that. The patient said yes, but his brother begged the physician to admit him to the hospital.
I left the ER, finally, because I had to head to another meeting (and study the rest of the evening) but after being so privileged to be a part of those intimate moments my head was buzzing and I felt like I was floating. I'll be back for sure.
For background, I had actually never thought about becoming an ER physician until I started interviewing for medical school. I had been of the opinion that I would be personally frustrated by stabilizing and not treating patients. However my interview at the medical school I currently attend was with an ER physician and I just loved hearing him talk about his work. The biggest thing that struck me was that he said, I am the very last type of physician who says, I will try to help no matter what; no matter who you are, what you have (or don't), if you have insurance, if you speak english, if you live here or are just visiting - I will try to help. And while I think that speaks to the flaws of our medical system, it's also true.
So I arrive in the ER around 2 pm with my stethoscope and lots of questions. Over the course of the time we saw so many patients that there isn't space to recount them all, so I'll just pick two.
The first was a man who came in an ambulance having grand mal seizures and potentially a heart attack. It was the first case where I got to see the ER respond. It was almost like a dance; the physician I shadowed prepared to create an airway down this man's throat, the nurses set up all sorts of medication stations, the charge nurse (the head nurse) coordinated with the paramedics so that when they arrived, they knew exactly which room to come into and what to expect. They cut off his clothes, hooked him up to monitors for his heart, breathing, and blood pressure. Then the physician started talking to him, in between seizures, to check to see if he could be responsive. He grabbed her hand and dug his nails in hard. They got him hooked up to oxygen, made sure there was nothing for him to hit, and started to give him medications to help break his seizure.
The second was an older man who came in with his brother. He was incredibly thin and pale and his brother was scared because he had not wanted to get out of bed that morning or eat anything. The physician I was shadowing asked them about their history and found out that the patient was terminally ill and had spoken with a hospice care worker with whom he (and his brother) had decided that he would be comfortable at home. His brother, it seemed, was rethinking that decision as the patient was getting closer and closer to actually dying. The physician explained what hospice care was and asked the patient if he still wanted to do that. The patient said yes, but his brother begged the physician to admit him to the hospital.
I left the ER, finally, because I had to head to another meeting (and study the rest of the evening) but after being so privileged to be a part of those intimate moments my head was buzzing and I felt like I was floating. I'll be back for sure.
November 12, 2009
Womens Choice v. Health Care for All
I was shocked to read in a NYT article today that the new health care reform bill proposed by the US Senate includes language stating that the federal health plan would not cover abortion services - AND that if a woman has the federal health plan, she cannot also purchase insurance that would cover it. In an incredibly articulate article, Kate Michaelman (former president of NARAL) and Francis Kissling (former president of Catholics for Choice) lay out how these choices are being put on the back burner for another day's fight instead of being seen as intimately connected to health care.
Read more here.
Read more here.
November 7, 2009
Your Brain on Football (er...collisions)
My only real source of consistent news these days - outside of medical school and word-of-mouth from friends and family - is the New Yorker magazine. When I began medical school I decided 2 things: 1) I wanted some sort of news source that would be shorter articles, entertaining, current, and involved in many spheres of life besides medicine 2) the new yorker had a big recession-style sale on subscriptions (and they threw in a free umbrella).
One story that particularly struck me recently was a report by Malcolm Gladwell on the impact of football (and boxing) on the brain. Gladwell talks with Dr. Ann McKee who runs the research program at the VA in Boston looking at brains of sports players found strange brain patterns in autopsies of football players (specifically linemen) and boxers. The patterns include scarring on the front and back of the brain - where it's been hit against the skull) as well as tissue blockage patterns that are more severe than she has seen in the brains of people who had Alzheimer's.
He also talks to researchers at UNC who have figured out how to put sensors in the football helmets of the players that record the force of each hit they take. The force is measured in how many times the force of gravity it is (e.g. 76g = 76 times the force of gravity). These guys - who are not even professional football players - were regularly taking 60g, 70g hits - in practice and in games. The researchers said it has been incredibly revealing because concussions often occur after a much smaller hit (23g, for example) even though the 70g hit the guy took in practice earlier that week didn't knock him out. It has led them to conclude that concussions do cumulative damage.
Gladwell talks briefly with the Chairman of the NFL about possible fixes to what seems to be proof that football, specifically the lineman position, is severely hurting people's brains. The thing is, the chairman says, football's not going anywhere, and as long as people love it, boys will grow up wanting to play it. We've thought about limiting professional careers to <6 years, but that's really just when a player starts to get valuable. So it's tough.
I'm not sure if there is solution to this - but I know that if I have sons (or daughters), I'm definitely not supporting any dreams of being a center.
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"some people think football is a matter of life or death. I assure you it's more serious than that." - Bill Shankley (*he was talking about the other football)
One story that particularly struck me recently was a report by Malcolm Gladwell on the impact of football (and boxing) on the brain. Gladwell talks with Dr. Ann McKee who runs the research program at the VA in Boston looking at brains of sports players found strange brain patterns in autopsies of football players (specifically linemen) and boxers. The patterns include scarring on the front and back of the brain - where it's been hit against the skull) as well as tissue blockage patterns that are more severe than she has seen in the brains of people who had Alzheimer's.
He also talks to researchers at UNC who have figured out how to put sensors in the football helmets of the players that record the force of each hit they take. The force is measured in how many times the force of gravity it is (e.g. 76g = 76 times the force of gravity). These guys - who are not even professional football players - were regularly taking 60g, 70g hits - in practice and in games. The researchers said it has been incredibly revealing because concussions often occur after a much smaller hit (23g, for example) even though the 70g hit the guy took in practice earlier that week didn't knock him out. It has led them to conclude that concussions do cumulative damage.
Gladwell talks briefly with the Chairman of the NFL about possible fixes to what seems to be proof that football, specifically the lineman position, is severely hurting people's brains. The thing is, the chairman says, football's not going anywhere, and as long as people love it, boys will grow up wanting to play it. We've thought about limiting professional careers to <6 years, but that's really just when a player starts to get valuable. So it's tough.
I'm not sure if there is solution to this - but I know that if I have sons (or daughters), I'm definitely not supporting any dreams of being a center.
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"some people think football is a matter of life or death. I assure you it's more serious than that." - Bill Shankley (*he was talking about the other football)
October 11, 2009
gray's anatomy for real
What is up with the cadaver dissection in medical school?
Since the last time I wrote (which now I realize is a while ago) I have started our anatomy/histology/imaging/doctoring skills block - which is to say that I am dissecting a cadaver daily as well as practicing doctoring skills (right now skeletal screening exam, apparently sometime soon, prostate screening exam!), learning how to read radiology tests (at a pre-novice level), and understand what slides of cells are telling me about the health of tissue.
I have been wanting to write about our cadaver dissection but am still not sure how I feel about it. I had such mixed feelings going into it and I'm not sure if they've changed all that much since starting. Dissecting a cadaver seems like the keystone experience for medical school - it teaches you to objectify the human body into parts, it forces you to confront your own mortality, and teaches you things you could never learn about the human body in a live being.
The cadaver I've been assigned to for the first month (of 3) died at the age of 54 from pancreatic cancer. He's only a year older than my own father and doesn't look sickly or anything. Oh, except that he's dead. I think that his young age has made it more strange for me - because he doesn't look old and shriveled and like maybe he lived a long life and this truly is resting. He looks like any man I could see talking with his buddies on the side of his son's football game, drinking a beer and having a hot dog.
Except that he's dead.
And I'm dissecting his body.
And the thing is - it's probably the coolest thing I've ever done. This past week, we dissected the entire arm - so I can tell you what all those veins and nerves are in your hands - what muscle you use to open a refrigerator or hold a lover's hand; I know why only your pinky and your ring finger go numb when you hit your funny bone; I know the name of your funny bone. This means that over half of the time, I'm in complete awe of the awesomeness that is the human body. For example, our circulatory system has set up a split in your brachial artery (big artery that supplies blood to most of your arm) around your elbow - on both sides - so that you can bend your elbow (to hold a baby, to do a biceps curl) and still get blood flow to your hands.
Perhaps my mixed feelings can be represented by a moment that happened a few weeks ago when we were removing a part of our cadavers spine:
For those of you who have not ever chiseled a spine (and I hope that's all of you) - your spine is really hard. my group had to take two minute turns because it was harder than constructing my bed. As I passed on the chisel and hammer to the next person, I realized I was standing next to our cadaver and rubbing his (still skin-encased, so somewhat normal looking) arm, trying to be soothing - as I watched my lab partners chisel his spine. It was the strangest moment and I'm still not sure what to take from it.
We've been able to talk a lot about how we're feeling about all of it - and what I keep coming up with is that the best way I can honor this incredible gift is to learn as much as I possibly can from this experience.
Since the last time I wrote (which now I realize is a while ago) I have started our anatomy/histology/imaging/doctoring skills block - which is to say that I am dissecting a cadaver daily as well as practicing doctoring skills (right now skeletal screening exam, apparently sometime soon, prostate screening exam!), learning how to read radiology tests (at a pre-novice level), and understand what slides of cells are telling me about the health of tissue.
I have been wanting to write about our cadaver dissection but am still not sure how I feel about it. I had such mixed feelings going into it and I'm not sure if they've changed all that much since starting. Dissecting a cadaver seems like the keystone experience for medical school - it teaches you to objectify the human body into parts, it forces you to confront your own mortality, and teaches you things you could never learn about the human body in a live being.
The cadaver I've been assigned to for the first month (of 3) died at the age of 54 from pancreatic cancer. He's only a year older than my own father and doesn't look sickly or anything. Oh, except that he's dead. I think that his young age has made it more strange for me - because he doesn't look old and shriveled and like maybe he lived a long life and this truly is resting. He looks like any man I could see talking with his buddies on the side of his son's football game, drinking a beer and having a hot dog.
Except that he's dead.
And I'm dissecting his body.
And the thing is - it's probably the coolest thing I've ever done. This past week, we dissected the entire arm - so I can tell you what all those veins and nerves are in your hands - what muscle you use to open a refrigerator or hold a lover's hand; I know why only your pinky and your ring finger go numb when you hit your funny bone; I know the name of your funny bone. This means that over half of the time, I'm in complete awe of the awesomeness that is the human body. For example, our circulatory system has set up a split in your brachial artery (big artery that supplies blood to most of your arm) around your elbow - on both sides - so that you can bend your elbow (to hold a baby, to do a biceps curl) and still get blood flow to your hands.
Perhaps my mixed feelings can be represented by a moment that happened a few weeks ago when we were removing a part of our cadavers spine:
For those of you who have not ever chiseled a spine (and I hope that's all of you) - your spine is really hard. my group had to take two minute turns because it was harder than constructing my bed. As I passed on the chisel and hammer to the next person, I realized I was standing next to our cadaver and rubbing his (still skin-encased, so somewhat normal looking) arm, trying to be soothing - as I watched my lab partners chisel his spine. It was the strangest moment and I'm still not sure what to take from it.
We've been able to talk a lot about how we're feeling about all of it - and what I keep coming up with is that the best way I can honor this incredible gift is to learn as much as I possibly can from this experience.
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