Tools of the Trade

Y'all are in for a treat today! I'm going to introduce you to the contents of my "doctor bag!" Yes, I really do have an actual black "doctor bag" that I keep things in when I'm at home to stay organized, but when I go to clinic I just stuff these tools in one of the million pockets I have in my white coat. "Doctor bags" really aren't very popular any more, but I still like mine because it reminds me of the TV show "Dr. Quinn, Medicine Woman" which I watched quite a bit growing up and it makes me feel all official/like a real doctor.

 Here's what I have:

safety pins, alcohol prep pads, ophthalmoscope, otoscope, reflex hammer, tape measure, tuning forks
(starting in lower right corner and moving clockwise) 

• Safety pins: These are used in testing sensory portions of the nervous system ("Can you feel this if I poke you with the really sharp pointy part? What about now, if I poke with the rounded part?"). Also they come in handy if you snap a button off a dress or your pants are too long and need a quick fix.
• Alcohol prep pads: These are used in many instances, but basically the purpose is to get something clean. We use these if we are sharing tools between pairs of people when practicing and also to get marker off our skin after drawing muscles, ribs, lungs, hearts, etc on each other to get a better understanding of where these structures reside in the living person.  
• Ophthalmoscope: We use these scopes to look in eyes. We might be looking for pupillary reflexes, the red reflex (this is what makes red eyes when you take pictures!), at the retina, optic disk, optic cup, veins, arteries, etc. Ophthalmologists look at quite a few more things and fully understand all of the tricks of this tool, but at this point I just know to look for the things I've already listed. 
• Otoscope: Similar to the ophthalmoscope, these are multi-use! As the name implies (oto-), these are used to look in the ears. There are disposable tips in the picture too, which we use so we don't have to sterilize the scope after each use! Doctors also will use this light to look in the nose and in the mouth at the back of the throat (uvula, tonsils, etc) [Say Ahhhhhhh!]. This light can also be used to check pupillary reflexes, but definitely not to look at the eyes because you will gouge the patient's eyes out if you try! 
• Reflex hammer: This tests reflexes, just as the name suggests. This particular one is used by neurologists more than any other specialty, but it does the same sort of thing. The handle can also be used to check some sensory information (Is this cold or hot? Smooth or sharp?).
• Tape measure: Well this measures things. Y'all have seen these before. We may use them to measure the circumference of the head in children or many other things!
• Tuning forks: Well these are used in neurology fairly frequently. But we just used them in our head and neck unit to test for deafness (and to distinguish between conduction and nerve deafness). 

Don't worry, that's not it! There's more....! I also have two stethoscopes. One is for adults, there's nothing particularly exciting about it. The other one is a pediatric stethoscope. I just got it in the mail this week. It's seriously awesome....look!

It's rainbow!!! It also has my name on it (thanks Aunt Lorraine and Uncle Dick!). I'm super stoked about it!


BUT WAIT. That's not all! 

It's a DINOSAUR!! How sweet is that?!
I can't wait to go into the clinic and have this super awesome cover! 

I also have a Dalmatian cover, so I can switch them out! 

So that's what I have in the bag. I also have an eye chart and a few other helpful tools that I keep in my white coat that never make it to the "doctor bag." I'm excited to continue learning about these tools and to expand my clinical knowledge. This week I have my first videotaped interview with a standardized patient. It will be interesting to watch and critique my own patient interactions!

Other than the grammatical error, this holds pretty true! 

Letter to a Future Doctor

So I've been feeling really unbalanced lately. Almost like I've been missing something. Throughout the entirety of my college career, I balanced my studies in the science-y genres with my Christian Ministry minor and Religion major classes in the humanity genres. But for the past 5 weeks I've been solely doing science--and quite a bit of science at that!

So today, I poked around until I found an email that I saved over 2 years ago just in case I would ever need it. This email contained a letter from the founder of Church Health Center to future doctors. Many of you already know about Church Health Center (CHC). But if you don't, here's a quick run-down:

CHC is a non-profit in Memphis, TN which provides medical care to the working uninsured of Memphis. In addition, they have a preventative health/wellness center with all of the amenities that you would of expect of a YMCA on steroids. They have childcare (where I worked for a total of 6 months), physical therapy, a sports court, exercise classes, healthy living classes, healthy cooking classes, outreach programs, and much, much more. This place forever changed my life and the people there also have greatly impacted who I've become. Well anyway, Dr. Morris (the founder) believes that Christians are called to preach, teach and to heal and that we, as a church, don't do so well with the healing part. Essentially the CHC crew works to help patients and members to be healthy in mind, body and spirit.

Recently I've noticed how much I've been missing the "spirit" portion of my education since starting medical school. I understand that I'm hear to learn the "hard science"part of medicine, but I still feel drained. This letter was just what I needed to "fill my bucket" amidst the grind of anatomy.

Dear Future Doctor, 

Congratulations on entering medical school. I know it has been a long, difficult path to get to this point, but you have made it to the beginning of a life-changing experience. What I hope is that it doesn’t change you too much. 

Most students just starting out still identify more with being a patient than a physician, but the moment they place that white coat on your shoulders, you will begin the transition, both intellectually and spiritually, that will make you a doctor. The part of this path that teaches you the skills to care for people is a good thing, but there is a negative side of this transformation that I hope you will fight. 

This will begin the day you walk into the anatomy lab. It is a surreal experience to be in a room with a collection of dead bodies that you and your classmates will cut and dissect over several months. Someone will make a joke about how creepy it is, and then the bodies will be given nicknames that will make you laugh. But remember that your cadaver was once a real human being who cared enough about your medical education to give you his or her body to learn from. What a remarkable gift! This lifeless corpse was once someone’s father or mother, who had dreams and aspirations, just like you. They loved and cried but, when you do your dissection, you will not find the source of these vital parts of life. We need to offer the body the greatest respect. God’s gift of this mortal coil is part of what makes us human. All too often, however, medical students in anatomy class lose reverence for the body, and for some students, this begins to erode a sense of awe for life itself. Don’t let it happen to you. 

For the next two years, you will spend endless time in a classroom and feel great pressure to accurately regurgitate information that you have memorized. You will see the students in classes ahead of you as mentors, but remember they have only a little more experience than you. Do not try to impress your teachers with how familiar you are with the practice of medicine when, in reality, it is all still very new to you. 

When I was a second year student, my partner in our physical diagnosis class began a presentation to the attending by saying, “This was not a very interesting patient. She only has diabetes.” I have now been a practicing physician for 25 years and, even now, I learn new things about diabetes. Surely, one of the first times you are seeing a patient with this disease it should be interesting, but even more so, objectifying the person in your care to only their disease is wrong. This is not a way to become a healer. 

Some teachers will tell you that you should not allow yourself to get close emotionally to your patients. In order to keep your mind clean, they will say, you must stay objective and learn to keep your distance. Nothing is further from the truth. We do not need to teach people how to keep their distance from other people. We do that naturally. We need to teach how to become close to another person in a professional manner. To practice the art of medicine, we must learn how to care for people. 

Still, no matter how hard you try, at some level you will be converted to the religion of medicine and, trust me, it is a religion unto itself. There are fundamental beliefs that cannot be violated; holy places and sanctuaries of learning; prophets and high priests of the profession; and a way of seeing the world that changes how you see yourself and others. Many medical students and residents get to a point that they cannot talk about anything except medicine, so when they go to parties, they either gravitate to the other true believers like themselves, i.e., other medical students, or they bore other people with self-centered monologues. I urge you to continue to have a life outside of medicine. Learn to listen to other people’s stories and pay attention to what matters to them. It will make you a better physician. 

Still, medical school will change you. One day, as a third-year student, I was doing CPR on an elderly woman and the resident came into the room and began taking orders for pizza when the “code” was over. A person’s life was literally underneath my hands, and while I was doing chest compressions, I was thinking about whether I wanted mushrooms on my pizza. In that moment, I knew medical school had changed me, and I am embarrassed today to admit that I had those thoughts. When I realized what was happening, I promised myself to never let it happen again. 

When you graduate from medical school, you will no longer identify yourself as a patient. Now you will see yourself as a “doctor.” This is a good thing – something to be proud of and to build on. But, during these arduous four years, my prayer for you is that you do not lose your love and reverence for life along the way. Remember that God has given you the ability and the skills to become a physician in order to keep life holy. Being a physician will allow you to more fully answer the call to discipleship – to preach, to teach and to heal.

You are on a spiritual journey, and medical school is giving you the skills to help you and others live life in the fullness that God intended. These four years, though difficult, constitute the beginning of your own full and well-lived life. 

With great hope for your future, 

G. Scott Morris, M.D., M.DIV

I'm feeling better about my bucket being filled and my spirit being renewed. I am so thankful for the great people at CHC to remind me of such things from afar. I am also glad that Dr. Morris addresses that fact that none of us know what we're are doing. Today we had our very first standardized patient. These patients are trained to know how to evaluate the skills which we are supposed to be practicing and such. Today we were just supposed to work on patient histories. I didn't interview anyone today, but it was a really great experience seeing several of my classmates go through the process. We were all scared, we were all nervous, and none of us knew what to do. But it was okay, actually it was a good sign. It meant that we took it seriously--that we realize how much of a responsibility it is to be in charge of the care of a real human being. These standardized patients are a great way for us to practice in a safe environment so we are fully prepared when we are actually in the clinical setting. I'm nervous and anxious for my standardized patient next week! Until then, I will continue to learn about the thoracic cavity and rejuvenate my spirit. 

"Be aware of wonder. Live a balanced life--learn some and think some and draw and paint and sing and dance and play and work every day some." 

Robert Fulghum

Pre-exam preparations

I'm sure that you're all dying to know about what I do to prepare for my exams. Well beyond the obvious answer of study, study, study, study, study, study, study, study and study more, we've actually started a few pre-exam traditions! Whether they truthfully are all that helpful or not is probably debatable, but there is at least a grain or two of physiologic support for these rituals.

On Thursday nights we eat pasta. Carbo-loading is something that is quite common in athletes so they have enough of a store of energy for a big meet/match/game, so why not do it for our very own logic workout?! This week I added a bit of pesto, Alfredo sauce and sauteed vegetables (red pepper, mushroom and Swiss chard) to my pasta. It was absolutely delicious! 

Pre-exam Friday nights are sushi nights. We're trying out the local sushi restaurants to decide which is our favorite, but so far we've had good experiences at the two places we've frequented. The fish gives us some Omega fatty acids to help us think too. Tonight I actually ordered a Bento box. I had miso soup, teriyaki salmon, a California roll and several tempura-ed things (shrimp, broccoli, mushrooms, zucchini, etc). It was DELICIOUS! 

Truthfully, these two rituals are the most exciting part of the week leading up to the test--arguably the most exciting thing that happens throughout the entire 2-3 weeks we are studying a particular unit. 

Friday nights we also spend reviewing living anatomy (it's exactly what it sounds like...finding the anatomy of living people). This unit is all about head and neck, so the living portion of the exam will include: cranial nerve testing; muscle testing for the extraoccular muscles, muscles of mastication, muscles of facial expression, supra- and infrahyoid muscles, and other muscles of the neck (including intrinsic laryngeal and pharyngeal muscles); cervical plexus and brachial plexus nerve testing; and looking in ears, eyes, noses, and mouths. It should be pretty sweet. I also review slides from embryology on Friday nights. We get questions about different embryological derivates of tissue, times at which different structures emerge and what could go wrong if the genetic programs don't function properly. Embryology is a really sad class because we spend so much time learning about everything that can go wrong and never hear about the things that go right. This class has made me absolutely terrified of becoming pregnant and having children (the fourth week of pregnancy is a seriously big deal....holy goodness!). But that decision will be made much further down on the road of life. Creating and growing a human is an absolute miracle!! 

The great news for tonight is that I FINALLY understand the arteries of the face and neck. Truthfully they aren't too difficult, but I could not wrap my mind around them for the past two weeks. Luckily, it all 'clicked' tonight and I'm hoping that it stays that way for the exam too! The trouble with the arterial system (the venous system is the worst offender at this though...far worse than the arteries!) is that they are variable. The body we are dissecting has his arteries branching in a non-traditional manner, yet they aren't so non-traditional that they are an anomaly (something that happens in less than 15% of people is considered an anomaly for our intents and purposes). But then if I go to another body, they'll branch differently as well. So confusing and frustrating for me...until now! Here's a (fairly) simply diagram of the arteries of the head and neck, just so you can get a visual picture of it.

One of the craziest things is that arteries anastomose (reconnect/join other arteries) with arteries that are from the same major trunks and from different major trunks. And then they also anastomose across the face and neck--don't forget you do have two of almost everything! They do all of this so that no area of the face, neck, brain is ever without a blood supply even if one artery gets clogged or something. 

Isn't the body just so cool? Well anyway, my pre-exam preparations always conclude with a full night's sleep, so I'm off for now! 

Duh, welcome to medical school

Well, as it turns out, I could have done a billion times better on the practical tonight (it's not graded, it's just to give us an idea about where we're at) if I would have actually studied a few areas a bit better--or at all. Now I quite easily understand the relationship between the auditory canal, tarus tubarius and the salpingopharyngeal fold and muscle. Obviously those terms mean nothing to many of you (and truthfully they are in an eeentsy little area near the junction of the nose and the mouth), but they make a thousand times more sense to me right now after spending 5 minutes looking at them in a dissecting guide than they did earlier tonight. Who woulda thunk that studying actually helps!?!

Wow, such deep and wonderful insights tonight. Clearly I need to get my head out of a book more frequently or else I may lose my common sense altogether! Here ends my late night ramblings. Until another day.

Long time, no post.

So it's been a while since my last post. It's test week, so I'm not going to take the time right now to fill you in on everything, but here's a little glimpse into what I've been doing today.

Facial nerve (cranial nerve 7) branches starting in the brain and going to their respective locations. Also, there's a bit of trigeminal nerve (cranial nerve 5) thrown in there.

This is the path of the glossopharyngeal nerve (cranial nerve 9). It seems less scary than the facial nerve because there are fewer branches; however, it still has motor, general sensory, parasympathetic and sympathetic fibers throughout its course. 

Pterygopalatine ganglion. One of my least favorite ganglia (collection of nerve cell bodies outside the Central Nervous System). 

Welp, that's basically what I've been doing with my life. Tonight we also had a practice practical to prepare us for this weekend's exam. I didn't do so well tonight, so I'll be spending more time in the lab tomorrow! Look for a longer post sometime this weekend when I will have more than a few minutes to spare for blog writing.

LCE

Today was my first long-term clinical experience (LCE) visit. Basically I am paired with a local practitioner (in my case, a pediatrician) for the next two years. I need to make 5 visits a semester with him at the clinic. It's designed to get us into the clinic to see patients (you know, the whole reason all of us wanted to be doctors in the first place) right from the get go.

So I really can't say much about the patients or anything that happened this afternoon, but it was a wonderful visit! We had one particular moment that was absolutely hysterical though that I can share. We were doing a Kindergarten check-up on a 5-year-old boy and the doctor was asking him a few questions to determine where he was developmentally.

Doctor: "What's your address?"
Boy: "Ummm, I don't know."
Doctor: "Do you know what city you live in?"
Boy: "I don't remember."
Doctor: "It starts with 'O'."
Boy: "O-merica!"

It was absolutely adorable! Go 'Merica! Needless to say, the little boy eventually remembered that he lived in Omaha, so the doctor determined that he was okay.

Such a wonderful visit and a great reminder about why I'm going to school for seemingly forever. Adios for now.

Happy Birthday to me!

Well, today is my birthday. I am officially a 22 year old. I guess that's old, but I don't really feel that much is different from yesterday. Maybe that's because I'm amidst the medical school grind. Oh and probably because I'm still one of the youngest (maybe the youngest actually, I have yet to meet someone younger!) in my class.

Today is a really good day. Not only did I get to hear from a gaggle of my friends and family, but I also got to...

1. Hold a real HUMAN brain!!!!
2. Eat my mom's homemade carrot cake. I'm really not sure that there is a better cake in existence.  
3. Begin dance classes at a local dance studio! It's been 4 years since I've consistently taken classes at a studio, so I was nervous to begin. I've really missed dancing since HC dance team ended in February, so it was nice to be back at it. The class wasn't as challenging as I expected, but dancing is still dancing. Tonight was lyrical and tomorrow will be jazz.
4. Wear my special cupcake necklace that is for birthday celebrations only! A local artist made it and my best friend Laura gave it to me a few years ago for my birthday present. I absolutely adore it! 
5. Go out for ice cream with my wonderful roommate. But she lost some roomie points because she was a jerk and put my gift in this bag: 

For those of you who don't know, I'm absolutely terrified of squirrels.  No seriously, I HATE them. Of course the running joke is always to get me squirrel-related presents, but seriously, on my birthday?!?? Anyway, she made up for it because she got me an AWESOME scarf and beautiful earrings.

So, some of you might not understand why holding a real human brain is so cool, but don't worry. I'm going to tell you my top reasons for why the brain is so freaking awesome. It's seriously incredible, but I think it's even more amazing because it does all of its cool brainy stuff in just 3-5 lbs of weight! I suppose that means that I can't use the excuse that "my brain is getting bigger" while at med school if I put on weight from study-snacking...

Look, even this picture depicts how awesome brains are. Aren't those glasses pretty snazzy? I sure think so!

Okay, but now what y'all have been waiting for...my top reasons the brain is awesome (I don't want to put a numerical limit on my reasons, because I'm sure to find out more as the years progress)!

The brain is awesome because...

1. Your personality is in there. What makes you distinctly YOU resides just above your eyes in the frontal cortex. Scientists (whether neurobiologists or psychologists) don't really even understand how it works...how cool is that!?!
2. It works on electricity. Seriously! Just like the stuff that comes out of the wall. Except I don't suggest that you add any additional external electricity to your brain because electrocution is a bad deal. Plus the body makes its own based on ion gradients (yay, biochem!).
3. It sends out cells to receive sensory information throughout your whole body (light touch, sharp touch, pain, proprioception), BUT it doesn't even have its own sensory cells! Once you get beyond the nerves of the bone and meninges (3 protective layers over brain and spinal cord), the brain doesn't actually "feel" anything. That's the reason why patients can stay awake during brain surgery! 
4. The brain processes things seriously quickly. We have some incredible computing ability up there and usually it goes faster than any machine that humans have built to date. 
5. All of your muscles work because of electrical signals (more electricity) sent from the brain. Think about how complex the motion of waving goodbye is... (1) Visualizing person to say goodbye to, (2) Processing thought "I want to say goodbye," (3) Raising arm at shoulder joint, extending forearm, making 'bye-bye' motion with fingers and wrist involvement, lowering arm, etc. That's a gross oversimplification of the process but you get the idea. AND there are a bunch of muscles involved in each of those actions that are even given their signal (innervation) by different nerves. All of those things have to go right for us to do even something as simple as waving. 
6. You don't have to think of automatic processes like breathing, blinking, temperature control, digesting, etc. Interestingly, you can also control some of these processes consciously too. 
7. The brain doesn't sleep. Even while your body catches some Zzzs the brain is processing and organizing information and experiences of the previous day(s). AND it is repairing itself (within reason) throughout all of that.
8. Speaking of sleep....dreams. Those are some crazy things. 
9. You have memories. We don't even realize that we remember most of the things that we do!
10. The brain is also controlled by chemicals. These chemicals work with the electricity to send signals to other parts of the body. Lots of diseases/disorders arise because of an imbalance of these chemicals. 

Okay, 10 reasons will be enough for today. I probably should actually do some studying. Surprisingly, the professors didn't give me the day off even though it's my birthday ;) (kidding, I never expected them to). 

Thank you to everyone who made this day extra special! I am seriously overwhelmed by the love and support I have felt today from all of you. Here's to another great year! 

Head and Neck: Day 1

So this might be a little gruesome, but today we finally looked at the face of our cadaver. Truthfully, it wasn't as hard as I thought it would be because the skin (the most distinctly personal and identity-tied part of the body) didn't stay on for too long. But moving on to the less gross parts of my day... We looked at the muscles, nerves and arteries of the face, which are pretty cool things. The facial expression muscles are ridiculous! But if you think about it, we communicate with our non-verbals so frequently and most of that communication occurs with our facial expressions.

Over the lunch hour we had a meeting for the Pediatric Interest Group (PIG). A Child Life specialist from the hospital came over to talk to us about the hospital buddies program. You can watch a little about the program here. It was really emotional for me when I was learning about the program because it reminded me so much of my Memphis kiddos (one of the young girls looked IDENTICAL to one of my CHC kiddos). During the presentation, I had an overwhelming feeling of missing my good friend Rachel who is also a Child Life specialist. Rachel is quite a bit more energetic than the lady I met today, but few people in the world have as much energy as Rachel does (few people are also as awesome and nice as she is either).

This lady was teaching us about "getting on the child's level" so that you're not talking down to the child. I started giggling because I remember messing with Rachel and moving up, down, left and right while talking to her. She would adjust her level without even realizing and we would just laugh. It was evil, but oh-so-funny at the same time. I miss Rachel very, very much and think of her often. I hope that she and Bo are doing well and I know that her kiddos at Le Bonheur absolutely love her! I'm also sure that she's making billions of spiderweb flow charts on sticky notes still. :)

Well, I'm already feeling overwhelmed with the information we were given today in just two short hours of lecture and two hours of lab. I'm off to study! A large cup of coffee and Netter's Atlas of Human Anatomy are calling my name!

A Labor-less weekend

First off, a quick thank you to all of the day laborers that help to provide the goods and services that I all-too-easily take advantage of and forget to be thankful for. I hope that you got some time off this weekend to spend with your respective families. 

I survived my first exam! We won't find out our scores until late this week or the beginning of next week, so who knows how it actually went. It didn't seem too brutal though, which probably means it wasn't my best exam ever. Oh well, no use worrying over it now...it's done and over! 

This weekend I spent time at the lake with friends and also stopped by to see my parents on my way back to school. It was refreshing to see friends and family after a long, tiring week of studying. I drove the jet ski for the first time and my mom even baked a cake for me! Obviously I had a wonderful weekend based solely on those events. I spent so much time gasping for air and clutching my stomach as I laughed hysterically at the boys at the lake. Never a dull moment around them! I am so thankful to the Nevilles for continually inviting me back to spend time with them at their lake house! 

"testosterone-weekend"

This week we start the head and neck unit. I'm guessing that it will be really tough in lab, so please send up positive thought or two my way tomorrow mid-morning. We also learn about universal precautions tomorrow. After about 100 years of teaching HIV prevention education, I think I have a pretty solid understanding of them, so hopefully I don't get bored during that lecture. More updates to follow this week about lab.