Friday, June 20, 2014

First Last Summer Post

So begins my last summer. No, I'm not moving north of the Wall or foretelling my untimely demise. This is the last summer break I will get as a student. And like many med students, I'm voluntarily spending it productively and merely dreaming of the exotic destinations to which my wiser classmates have ventured. Earlier this week I, rather abruptly, started my summer clinical research "program" in the Pediatric Intensive Care Unit (PICU) at the local children's hospital. I hesitate to use the term program because that implies that there is some sort of plan, schedule or central organizing force. Like any great adventure, mine seems decidedly unscripted.

On Wednesday, I met with my primary advisor and was promptly told to create a ten minute presentation for the next morning to present to the twenty or so second year residents (doctors four years my senior)... and this presentation would be at the house of the pediatric residency director for the hospital... on a research project about which I only had cursory knowledge. Given the situation and the resultant lack of sleep, it went pretty well. Of course the audience wasn't exactly the most receptive I've ever had, as the project essentially creates slightly more work for some of the most overworked people in medicine. Rough crowd.

Thankfully, this summer experience is not all research based. At that first meeting with my project's PI, or principal investigator, I was also told that the entire PICU was open to me. I can attend morning rounds, departmental lectures, and unit meetings. I can shadow the residents and generally lurk about the unit as much as I want. I took my first opportunity at this this morning and joined the residents and their attending physician on morning rounds.

For the uninitiated, morning rounds are a daily exercise at teaching hospitals wherein the team of doctors physically tours the unit one bed at a time, discussing updates on the condition and current treatment plan for each patient. If you've ever been a patient or family member visiting during these early morning hours, you know it can be quite the imposing experience. In an ICU such as ours, the rooms are all private and open to the unit with huge glass double doors. The doctors stand in a semicircle around the door and talk to each other in a foreign language of acronyms, numbers, and medical terminology. The resident in charge of the patient gives a report to the attending with the help of the patient's current nurse. The attending gives his or her advice and pounces on every teaching opportunity to reinforce (or refute) with real life experience all the knowledge the young doctors have learned from books and classes.

The patient and their family are briefly greeted but this visit is not for them. This is the only time each day that all of the doctors are in the same place at once and there's no time to translate. As I am not nearly fluent myself, I spent most of my time this morning taking in the scene and watching the interactions of the players. The most interesting people were the parents. The ones with kids with chronic conditions smiled when we came by and politely listened. You could see them nod with recognition when they heard the key words that were important yesterday or a year ago during their last admission. The doctors also know that experienced parents can be valuable experts in their children's conditions and will ask their opinions.

The hardest part was watching the novice parents, having been thrust into this sterile world by a tragic accident or life-altering diagnosis. To them the words are useless; each could mean their child's salvation or condemnation, but they can't tell which. Instead they are doing the same as me and watching faces. Every sign of frustration or resignation from the doctors causes them physical pain. In teary desperation they seem to silently plead for someone to tell them it will be alright, if only so that they can more honestly whisper the same to their unconscious child.

People often ask how doctors and nurses can stand working in this world of innocent lives torn apart, possibly to never be put back together again. The best response I've heard is that it is these the patients who are most worth fighting for. I'd rather spend my energy on an innocent child with a full life of potential than, for instance, an elderly patient suffering from a self imposed ailment, even if the outcome is potentially more tragic with the child.

I'm looking forward to exploring more about the PICU and clinical research this summer and periodically sharing my existential musings with you. Thanks for reading!

Friday, June 13, 2014

First year follow-up

It's official! I survived first year.

Apologies for the delayed update, but unsurprisingly life continued to be super-crazy-busy even after classes ended. After some well deserved revelry, I sat down to review the year for this post.

My first stop was my first post - nothing special, just moving in. This gave me the brief hope that I might be able to peruse my way through the year and share my favorite moments. O, how wrong I was. Turns out that I wrote quite a bit through the last year. I would try to add up the word count... but I'm not going to.

I also learned an enormous amount of information. Given that I only wrote between one and maybe five facts a day, but learned was taught between a few dozen and a few hundred (I wish I were exaggerating) bits of information, it truly is an incredible accomplishment to simply survive a year. That being said, I am far prouder of my growth outside of the hippocampus (the brain structure central to memory consolidation).

My admittedly robust ego took so many hits in this year-long bout that I worried it might not get back up off the mat. Like a muggle-born kid from Hogwarts, I was often completely lost with things that other in-the-know students had learned years ago, either from parents or previous experience. For example: always assume you should wear a tie to a neurosurgery conference. Blood pressure cuffs do not, in fact, require three hands to hold. And always double-check the gender of your cadaver*.

I have also never been more stressed and generally miserable than during finals for the last two blocks. Most of you who know me know that I don't stress out easily. But excluding some of the worst days dealing with my own or my family's health problems, I've never been less happy than in the days before a test that could determine if get to continue this torture into the next block or the next year.

This is a subtle but important distinction. Even though, if I'm honest, I was afraid of being judged by my classmates, or failing the expectations of my family, or falling further behind my friends who are further in their education than I, my main motivation for passing my exams was getting to continue all the crazy, challenging, AMAZING things I get to do and learn every day at this school. I get to unravel the mysteries of the very body that allows to me unravel mysteries. I am (slowly) learning how to save lives not ten years after I was learning to heat up the "butter" they put on your popcorn at the theater.

I am so grateful for the privilege to be here and want to thank everyone who helps me get through the low days so that I can revel in the excitement of the exceptional ones. Thank you all again for reading!

* You may notice that my cadaver's gender as written in my posts went from male to genderless to female. When she was first introduced to us and throughout the first few sessions, the head and lower body were covered. Some combination of natural flat-chestedness and age-related tissue atrophy gave both the second-year who introduced us to the body, and my dissection group, the false impression of a male body. When the other group that shared our body started using female pronouns we were very confused before being very embarrassed.