Hospital Visit

For our last college mentor session, Dr. Cx took us to Parkland to meet with a patient and also get practice hearing various diastolic and systolic heart murmurs.

Regarding the latter, I am still extremely bad at detecting the murmurs. I have no idea what I'm looking for and where I am looking for it. But, Dr. Cx said that he was a junior resident before he could hear some of the murmurs. But once you hear it once, you will always be able to hear it. That is reassuring.

The more moving part of the day was our talk with our patient. She is a 25 year old woman battling stage 4 breast cancer that has metastasized all over her body... 25 years old.
She said that she felt a lump on her breast around 18-19 but didn't really do anything about it. However, around 24 years old, she said she couldn't eat anymore because of nausea and pain, lost about 60 lbs. The doctors originally said she had gastroentitis... the horrible thing is, they felt a lump on her breast and took an X-Ray, but she never got the results back. She's currently in a little law suit but that is absolutely terrible. The neglect and mistake of not even looking at an X-Ray result probably cost the patient her life... or severely shortened it. When they finally diagnosed her with cancer, she was already stage 4. The amazing thing is, however, it's been 14 months since her diagnosis. She has gone through bouts of chemotherapy and radiation therapy, and though she never feels 100% well or herself, she still is trying to live life normally. That's absolutely amazing..

But god... 25 years old. That is way too young. way way way too young.

SAGE Session: Senior Mentors

We just had the most incredible - absolutely inspirational - college session.

Last week, we interviewed/played with infants, children, and their parents to gain experience on the type of interaction and questions we should ask this age-specific patient group.

This week, we met our senior mentor, Ernest 'Bud' Mantz, a 90-year old man who really is.... a super man. I came out of the session so moved, so inspired, so excited about life and the future. I felt so honored to meet this man, to hear his stories, to receive his life advice...

So Bud, the superman. He has hiked, traveled, kayaked -- any physical activity ever possible -- all over the world. He starts his sentences nonchalantly like, "When I was on my last five miles of the Tour de France..." or "While I was hiking across the Sahara Desert..." He lives his life driven by what he described as a sincere, natural energy and passion to really.. be alive. He doesn't do what he does because it's "good for you" or "healthy" or "recommended" by physicians, philosophers, educators, whatever. Every day he lives, each moment is to fulfill his passions and to do what he loves with the people he loves. He embodies passion, raw energy, and love.

He gave us several pieces of advice which really.. made me teary-eyed.
One is to find the things that we would love to do... and just save the money and time to go do each and every one of them. It doesn't matter what a particular goal is - doesn't have to be some crazy adventure half-way across the world. Whatever draws us in like a natural magnet.
He told us that all of the regrets he has in life is not what he has done but what he has not done. I know we've all heard that before, but it vibrates so differently within when you hear it from this amazing person who truly lived life following that personal mantra.

He talked about how he used to be a hiking guide for this rugged, unmarked terrain somewhere in the US. He told us about this one time, he met this Native American man. During their conversation, the man held intently in front of his face a random piece of nature - a rock or leaf or twig - while gazing directly and deeply into Buds' eyes. Later on, the Native American man, alone in front of his fire, would get out those little amulets? reminders? of the people and places that have marked his memory and would thus no longer be alone. (Bud told us the name of those small trinkets -- but I forgot it at the moment -- managan? something like that.) Bud then told us to have something like that as well. Bud himself keep various notes of all of his important experiences. And, while he was hospitalized after an injury, he was able to look at those notes and be reminded that he is not alone - that his life has been filled with blessings, amazing people, unforgettable memories which are alive and within him each and every day.

AHH... I'm getting a little teary-eyed just thinking back to this afternoon...

I asked him if he has any secrets to a good, long-lasting marriage.
He said that each man and woman has his or her own set of interests and hobbies, but it's nice to be able to share passion and activities and adventures together. When he hiked across the Sahara, his wife followed because she "married him to be with him." However, he also said that spending too much time together can lead to irritation, so it's also nice to spend some time separately. So, for them, after a trip, his wife would go off to some city or country and go explore her own interests. Then, when she returned, "it'll be like honeymoon all over again."

Quick Update

It's been a while since my last post. Medical school is getting busier and more hectic.

We're currently in our physiology and cell biology block.
We finished our first CB test and just finished our 2nd physiology test (pulmonary and GI).
The tests were supposed to be on Fridays, 1 week apart (which means about 2 weeks of intense studying). However, due to the crazy weather, school was canceled for 4 days, resulting in the test being postponed to the next Wednesday. Let me tell you... that was hard on everyone's energy and drive. We were all ready to celebrate the end of 2 weeks of studying, enjoy the nice weekend. But instead, we were stuck indoors in the snow and ice. I definitely struggled to open my syllabus again.

However, that's what friends and colleagues are for. We were able to help each other keep up the study spirit, making sure we go through the entire syllabus yet again before the test on Wednesday.
I actually ended up scoring really well this last physio test - perhaps the extra time and extra help from friends was beneficial.

Today, we are having our first FULL physical exam practice with a standardized patient. 25 minutes. Video-taped. We are all not prepared... but hopefully, 25 minutes will go by quickly, and I'll be able to do the basic things that I know how to do (vitals, head/face/neck, cardiovascular and pulmonary...) I'm not as good with the abdomen, musculoskeletal, and nerve reflexes. But we have to learn and practice at some point.
They're really throwing us into this. But I guess that's just how things are. Everything has a start - sometimes it's an ease-in kind of thing, sometimes it's a blind-dive.

I wonder when we will begin transforming into the naive, immature students that we are to mature, professional physicians.

Standardized Patient: Abdominal Pain

For our second standardized patient interview, we were given a patient with complaints of abdominal pain.
However, the secondary task was to incorporate 4 techniques:

1) Following a Patient's Lead
So, if the patient is describing their chief complaint and mentions something on the side (ex: I should have come in earlier.... Since my mother passed away... I needed a way to wind down)

2) Redirection
If a patient begins to ramble on and on, end it with a comment of empathy and continue seeking further, medically pertinent information. (ex: This must be a rough time for you, and I would like to help in the way that I can. So, can you tell me more about the stomach pain you've been experiencing...)

3) Clarification
Patients can be vague. They can just say, it hurts. So clarify.

4) Sensitive topics
Drugs, Alcohol, Depression, Sexual issues --- never show judgment ever. We can use the "Sometimes" techniques. (ex: Sometimes, when people feel really low, they just feel like giving up. Have you ever felt this way?)


I had hoped that I would get a female patient this time, so I can practice asking questions about reproductive issues (especially with abdominal pain, since ectopic pregnancy could be a possibility). However, I actually interviewed the exact same patient as my first time. An older gentleman... but he's nice but gives good constructive criticism, so it's alright.

My patient had pain, which I had to clarify as abdominal, and he mentioned that drinking makes it better. Ding Ding. Drinking problem. So I expanded on that.
But I think I did a pretty good job at the non-judgment part - I treated his "drinking half a bottle of vodka a day for the pain" as "taking an advil whenever the pain occured."
What I need to improve on is saying Um and Er less!!
Also, I need to make sure and ask everything in the patient history template. I often forget to ask about social support.. or I'll ask about recreational drugs but not smoking, etc.

These standardized patient interviews are a good way to practice and can be kind of fun.
We've now received a USB that will save the video of every interview we do for these next 2 years. I hope to see a lot of improvement from now until end of MS1

first in-patient visit

53 year old man who came to the ER one day ago complaining of a sharp pain on his right side which radiated to his back, worsened when lying down, and was exacerbated by deep respiration. He had clear stomach distention. He expressed a history of alcoholic consumption and has also suffered from bilateral lower extremity edema.
Upon removal of 5L of fluid from his abdomen, he showed clear signs of improvement and the pain has been alleviated.

This was essentially how I presented my first in-patient to my mentor (as practice.. after she and other repeated it a few times). We had to have a Spanish interpreter with us, which was quite a new experience, but I think I had some pretty good practice. I'll be having to do a lot of presenting like this once I start rotations at the hospital.

Later, we went and looked up his chart and found that this gentleman most like has hepatitis C. The doctors are repeating the test to confirm before telling him the news. My mentor says that most likely, looking at his past and current state of health as well as SES, he only has a few months to hit. That reality hit me pretty hard.

I am really glad that medical school weaves in real patient interactions like these. I think it really reminds us what we are in medical school for. Not to make good grades. Not to learn how to pass a pass/fail course with good efficiency. Not to aim for top x% to make it into a certain residency program. We are here to learn how to treat, cure, and save lives. We are here to learn how to heal.
I have to admit that I forget this little detail all the time and get focused on other aspects of medical school. But that's why I really appreciate this 2 hour session with our mentors every week - brings the larger picture back into perspective.

Eric Morton Wang. ~in memory~

Trauma

According to the Global Burden of Disease Report, the leading cause of death for individuals younger than 45 is trauma. Out of the possible injuries, Traumatic Brain Injury (CDC factsheet) is the leading cause across all age groups.

The young are dying of trauma.


Unfortunately, due to the nature of this Cause of Death (often careless mistakes, unforeseeable accidents, etc.), funding for research on better traumatic care is limited. Trauma lacks a clear and definable target of pursuit (like Cancer). Trauma surgeons, however, are eager to learn better how to care for patients rushed into the ER with not even minutes - seconds - to spare before critical decisions must be made. Unfortunately, with insufficient academic work, surgeons must rely on instinct and experience. These are necessary skills for sure, but instinct and experience backed by empirical evidence is even stronger.


I feel that slower, more detailed surgical work is better suited for me, but I also feel that I am very calm and rational in intense circumstances. That has never been tested in a life or death matter, so I can't fully say anything, but that may be a good attribute to have for trauma surgeons.

We will see.

Missing Loved Ones, WTC Memorial - New York City

first standardized patient interview!

Was today.

It was actually so much fun, and I am now even more excited about my future career!
I had an older gentleman who came in complaining of constant fainting spells. Important points to hone in were frequency, duration, activities leading up, side symptoms (chest pain, heart palpitations, stress, changes in lifestyle/diet, etc.), and relevant medical history. Other important points were affecting and associated factors, medication, alcohol and/or recreational drug use. Some things the patient later said I should ask more were social factors - does he have a good support system? How does the fainting affect his lifestyle?

But I was told I made good eye contact, made smooth transitions between the questions, showed empathy, allowed him to ask questions and state concerns. His actual comments were: "I liked your direct and caring manner, very engaging and this made me feel confident in you as a doctor. I felt that you asked good follow up questions and gave a good summary."
All of these things may seem so common-commonsensical (I know I did while I was reviewing the lecture on patient interviews). But first time in a real clinical setting with a patient (doesn't matter that he's an actor) really made me nervous! I almost forgot what to do after I shook hands with him.  But after talking to him, hearing his story, I almost forgot that this was a training setting and all I wanted to do was take his concerns away. Make him feel reassured that we will take care of him.

I know some students here don't enjoy patient interaction and want to go into pathology or anesthesiology, but this is something for which I really felt a calling. And I am glad I enjoyed it so much because I really think an excellent physician not only has technique and skill (which can be taught...) but has the patient-oriented drive and motivation. I also would like to be the physician or surgeon that has the right instincts and can be creative. think outside the box. Those attributes, I have no idea whether I have yet or not, but what I need first and foremost is a solid background and knowledge.

So back to biochemistry studying!

Summer in Japan: Red Lanterns and Fuurins (ふうりん・glass wind chimes)