Thursday, March 23, 2006

Spring Break? What Spring Break?

This week marked my first Spring Break since beginning medical school. Now, I have never been one to maximize my spring break opportunities--I've never gone to tropical locations to sip drinks on the beach, nor have I backpacked throughout Europe during my one week respite from school work. Honestly, during undergrad I would usually spend the time cleaning my neglected apartment, watching movie trilogies on a near daily basis, and hoping the weather would clear up enough to go outside and play some baseball with my buddies. Certainly not exciting enough to trade stories with my friends that did take full advantage of their vacation, but it was relaxing enough.

This break has been entirely different. First, our class got slammed with a mountain of material just prior to break. I had anticipated avoiding such a fate because we had just completed block exams a week and a half before break began. I thought there would be no way that they could swamp us with more material than I could handle in that time, provided that I kept up with my daily studying. Turns out I was wrong, and severely underestimated the evil that is our Neuroscience course. In that class alone we covered the majority of the motor pathways from the brain, as well as the vast majority of sensory pathways providing information to the brain from the rest of the body. It might not seem like it, but that is truly a gaggle of information, and the problem was only compounded by the mess that is our course syllabus for that class.

We also had the opportunity to cover one of the more time-intensive systems in our physiology course: the kidneys. I find this course to be by far the most interesting of our classes this semester, but this block seems to be a sharp departure from the conceptual understanding that has been required during the cardiovascular and muscle blocks that we have covered thus far. Renal physiology, as it turns out, consists almost entirely of memorizing the fluid levels that make up our bodily fluids and enter and leave our kidneys, the electrolytes that leave and enter the urinary tract within the kidney and how they are transported where they need to go, and how to inhibit renal function. Sure, I think the material is pretty interesting, but it certainly takes some time to nail it all down. All in all, these are some pretty hefty subjects to try to master, and as a result, I have spent at least the average amount of time I spend studying on a day with lectures, studying at home during break. Not exactly what I had planned.

So, you might ask, what have I actually done for fun? Well, aside from playing with our new computer, I installed and completed the E.R Computer Game (yes, a Sims-type game actually based on the TV-series). Playing a game like this on my spring break from medical school is the kind of confession that I will only make on a somewhat anonymous internet site. Asked about it in person, I would assuredly deny all knowledge of such a game.

But seriously, I have had a great time with a couple of clinical mentoring visits. My first visit of the week was to a cardiac cath lab. For those who have not heard of such a magical place, let me run it down for you (and please excuse me for any inaccuracies). Cardiac catheterization is a procedure in which a cardiologist gains access to the heart through peripheral veins and arteries in a minimally invasive manner. They simply thread a catheter (kind of like a tiny wire) through the vessel and into the heart and then are able to perform a variety of functional tests, take images of the coronary arteries to get an idea of their patency, take tissue sample, or even perform interventional procedures, like placing a stent to prevent closing off of coronary arteries that could lead to a heart attack. I'm very interested in cardiology as a whole, but really find the idea of aggressively treating heart disease through catheterization to be really exciting. Needless to say, I felt incredibly lucky to watch two such procedures from the cath lab control booth, and was talked through watching the procedure the whole way by some very knowledgeable nurses. The cardiologists that I shadowed is great too, and seems to really enjoy being able to teach a younger student about the physiology and pathology behind his decisions while planning the procedure. I was even lucky enough to spend time that morning with a 3rd year Internal Medicine resident who will be starting his Cardiology fellowship next fall, and he was really great about answering my questions and making sure I understood what was happening. Anyways, both catheterizations were non-interventional, and resulted in collecting information about the degree of coronary artery disease of the patients, the pressures in the four chambers of the heart (which can tell you a great deal about their cardiovascular health and can help in a differential diagnosis), and how effective the heart was functioning as a pump. I found the experience to be fascinating, and I felt like a complete medgeek when I felt excited as I recognized terms and concepts that were being discussed from my physiology class. After the procedures were done I was invited back anytime I found the time, and I definitely plan on taking the cardiologist up on his offer. I'll make sure to post those experiences when they happen.

My other clinical experience this break was visiting my clinical mentor for a couple afternoons as part of a Clinical Continuum class for the first year students. At the beginning of the year we are assigned a mentor who usually works in primary care to shadow for at least 6 afternoons before classes end. My mentor is a family practice doctor who works in private practice. I feel like I learn a lot from my visits to him because he is very candid about the field of medicine, including its political aspects and the future problems that I may face as I work within it. He also has very good patient communication skills, and really does a great job of reaching each patient he sees on the level at which they feel comfortable. Definitely a skill that I hope to develop over the course of my career. He's also very good about teaching me about the medical concepts that we encounter as he sees his patients, and really treats me more like a colleague than the underling that I truly am. Anyways, today when I visited him, he let me take out stitches on a man who had previously had a procedure done in his office to remove a sebaceous cyst from the back of his neck. I had shadowed him during that procedure as well, and the patient recognized me, so I think he felt comfortable letting me take the stitches out even though it was obvious with the instruction that my mentor was giving that I had never done it before. The stitches came out fine, and I once again felt excited at the prospect that in only a little over a year I will be doing hospital rotations and gaining more and more hands-on experience with patients and learning how to perform simple medical procedures. I'm sure for him and the patient it was no big deal, but for a rookie like me I felt like it was a big step!

So that's a not-so-succinct summary of my break so far. Tomorrow I visit my mentor for one more afternoon and then hopefully I'll be able to spend my last weekend of freedom catching up with my wife, who's been swamped herself by work lately. I certainly don't feel more rested coming out of break than I did coming in, but my "medical batteries" have really been recharged and I feel like I can face my coursework for the rest of the semester with a lot more enthusiasm than I could muster for it before break. If it gets me to the point that the doctors I worked with this week are, I say bring on that next Neuroscience exam!


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