Categories
Humour Lifestyle

Study Strategies: The Good, The Bad, and The Ugly

The Tortoise
The tortoise is in it for the long haul. He studies for a fixed amount of time, every day. He has a routine. He never has to worry about cramming or catching up, because he’s always on top of things. The med school years for him are simple years; he studies and refrains from indulgence. Indulgence is too time consuming, and throws him off his rhythm. “If I party on Friday night,” he says, “then how will I get up at 6:30 to study on Saturday?”

The Hare
The hare is usually a social butterfly. So much energy, and so productive . . . in spurts. But the hare also enjoys taking time for herself. She takes evenings or maybe even whole days off studying. If she didn’t do this, she would fall victim to the dreaded burnout. At least that’s what she tells herself. Although she is often behind, her ability to catch up is second to none. Many of us have probably heard the adage that it’s impossible to cram in medical school. Well, not for the hare. Cramming for the hare just starts a few days earlier than it did in college. It really is impossible to cram for a neuro test the day before the test, but it is possible to pull 3 consecutive 20-hour cram days and still do well. As for long-term retention, who knows? Only boards will tell.

The Moocher
The moocher is lazy. He keeps to himself most weeks. He does not make study guides or contribute to anyone else’s learning. If at all possible, he will not show up to lecture. When a test is not looming, he can be found in his underwear at home, drinking beer and cruising the interwebs. Then, when a test looms near, he breaks free from his filthy cocoon of lethargy and can be seen on campus and social media snatching up all the condensed study guides everyone else in the class has made in the previous weeks. The moocher usually does okay on the tests, but one wonders how he will perform during rotations and residency when he does not have such helpful resources on hand.

The Memorizer
The memorizer is the queen of facts. Her ability to absorb large tables of seemingly random bits of information is unparalleled. While some may struggle to recall even the names of different medications, the memorizer will calmly recite all of the generic drug names, all of the brand names, how to spell them, how each of them is metabolized, their side effects, and which are contraindicated under what circumstances. She can do this after only going over the material once. Her classmates are in awe of her. Truly she is blessed.

The Reader
The reader… reads! Truly he is a rarity in our times. While he abhors the brute memorization of random facts, he loves to read textbooks. Bringing together a large body of knowledge into a logical system is what the reader enjoys most. He is a systematic learner who loves finding out how the little details fit into the bigger picture. The reader also must have strong shoulders, for textbooks are not known for being lightweight.

The High Yielder
The high yielder is focused first and foremost on the next exam. Perhaps it is a flaw, or maybe just an efficient allocation of her resources, but the only thing she cares about is information likely to be on the next test. She might be heard on campus saying something resembling the following: “Did the professor say that’s going to be on the test? No? Then I’m punting it. I’ll learn it later for boards if I have to.”

The Recluse
The recluse is only seen on mandatory days. Nobody really knows what he does. The only thing known for certain is that he does not go to class or social events. He doesn’t have a Facebook, and certainly shuns the company of others when he is forced to be on campus. The recluse may either be an actual loner, who would much rather be alone than in a group, or he may just be an older, married father of 3 who spends his time with family and studying at home. Either way, whenever he shows up, everybody turns and whispers to each other “Who IS that? Is he in our class?”

The Deity
The deity is revered by all. She is at the top of the class. Her study methods are mysterious. She somehow gets top scores on tests, actively participates in multiple clubs, is on student government, volunteers regularly at free clinics, and conducts research. She has a strong presence at social events and on social media. All of the students and professors adore her. Many have tried to discover her secret, but it remains a mystery. The current hypothesis is that she only sleeps 3 hours per night.

Featured image:
Studying in Starbucks by Nicola Sapiens De Mitri

Categories
Literature

The carpet-bag: what to bring with me?

In the first chapter of Moby Dick, “Loomings,” Ishmael gives his reasoning for going on a sailing journey. He is anxious, irritable, and needs to find an escape from his current life, symbolized by the land, so he plans on going to sea as a sailor. In my previous post, I likened his narrative in the first chapter, redolent of the famous Shakespearean monologues, to an exchange between a patient and a physician. I noted that understanding Ishmael’s narrative is analogous to understanding a patient’s story. In chapter two, “The Carpet-Bag,” Ishmael prepares for his sailing journey and leaves Manhattan island, but he faces a problem:

Quitting the good city of old Manhatto, I duly arrived in New Bedford. It was a Saturday night in December. Much was I disappointed upon learning that the little packet for   Nantucket had already sailed, and that no way of reaching that place would offer, till the following Monday (Ch. II)

Ishmael realizes he must look for a hotel to spend the cold December weekend. He surveys the area and finds several hotels: The Sword-Fish, The Crossed Harpoons, and The Trap. Finally, he stumbles upon one that seems reasonable, at least by its name:

Moving on, I at last came to a dim sort of light not far from the docks, and heard a forlorn creaking in the air; and looking up, saw a swinging sign over the door with a white painting upon it, faintly representing tall straight jet of misty spray, and these words underneath- “The Spouter Inn:- Peter Coffin.”Coffin?- Spouter?- Rather ominous in that particular connexion, thought I. But it is a common name in Nantucket, they say, and I  suppose this Peter here is an emigrant from there (Ch. II).

Here, Ishmael’s response to something seemingly as simple as the name of a hotel illustrates an important point—that the perception of language shapes how one feels about what one’s exposed to in life. This is a vital issue in science and medicine, one that deserves more attention in medical education. A few weeks ago, Dr. Mary Simmerling of Cornell University gave a lecture to first year medical students about the ethical, social, and economic issues surrounding kidney transplantation, and in her lecture, she talked about “how much language matters.”

As someone trained in philosophy, I’m very attuned to how the choices we make about words have a huge impact… And I think it’s so true when talking to patients. When I was in graduate school, we called what we now call ‘deceased donors,’ ’cadaveric donors’. So, who wants an organ from a cadaver, and who wants an organ from a deceased donor? Right? So, every word counts. And, it’s really important that we are careful in how we talk about things and describe them because it makes a big difference in how people think about things and how receptive they are, and how willing they are to do things. For example, ‘harvesting’ versus ‘recovering’ an organ—all these things that you might not think really make a difference… The way we talk about things has a huge impact on how the public thinks about them, how we think about things, and most importantly, about how the patients that you care for are going to understand and think about what you’re saying to them.

I’ll take Dr. Simmerling’s point one step further with a personal example. I recently participated in a small group discussion about taking a complete patient history, and the question came up of whether or not to ask about religious identification as part of the social history. I noted that asking about this issue is relevant but can be difficult to bring up in conversation. But there are ways to ease into this conversation. For example, asking patients what support groups they turn to in times of trouble is a better way to start this topic than asking directly about what religion they identify with. How can physicians be more conscientious about how they present information and ask questions? There are two ways, and the first is simply keeping this issue in mind while speaking to patients, students, or colleagues. The second way is to read more, and particularly imaginative literature and poetry, because such works are written in ways that require readers to be attuned to how language is used. Moby Dick gives readers a poem and play clothed in what appears to be a novel, but it really is an enormous prose-poem, and the dialogue between characters very much resembles interactions in Shakespeare’s plays. Reading Moby Dick is great practice for physicians and very much deserves to be alongside Bates’ Guide in a student’s carpet-bag.

Featured Image:
Moby Dick by Mal Jones

Categories
Lifestyle Public Health Reflection

Giving Blood

When my cousin mentioned that she wanted to give blood, I was happy because she voiced a wish of my own. I had wanted to donate blood for years, but I never met the eligibility criteria: either I didn’t weigh enough or I was anaemic. I had been fully eligible for over a year, but I kept postponing my donation for no reason other than the fear of facing the unknown alone. Having found another person to share the experience with, I was finally brave enough to follow through and donate.

I am a medical student, an aspiring Emergency Medicine specialist, an advocate of blood and organ donation, and I am fully eligible to give blood. Who better to donate than me? How can I expect other people, who are less aware of the need for blood products or the process of blood giving, to volunteer for this seemingly unpleasant act, without serving as an example?

Let me tell you, it was not a big deal. The whole experience was actually quite different from what I expected. I expected to be in pain, to feel dizzy and to have to spend a whole day preparing and recovering from giving blood. Here is what actually happened:

After a usual day of classes and a light lunch, we walked to the Croatian Institute for Transfusion Medicine, nervous but excited. We were met by very friendly staff, who responded to my nervous humour with witty jokes. I have to give them credit, because they made a big difference in my first experience. While they joked and kept the mood light, they were professional and reassuring.

The nurse who welcomed me didn’t believe I weighed enough, but a quick consult with the scale proved him wrong. After a quick check of my haemoglobin level and a small routine examination, I was given a questionnaire to fill out about my medical history, medication use, lifestyle and traveling.

It was encouraging to see that quite a few donation beds were taken. A few people seemed to be regular donators, as they chatted between themselves and with the staff, looking completely at ease. While waiting for a donation bed to clear, the staff chatted with me about medical university workload and our health system. After a very short wait, I was shown to a donation bed and got comfortable in a head-and-feet-up position. My cousin couldn’t give blood herself as she was anaemic, so she kept me company. I have to admit my eyes did widen at the sight of the 16 gauge needle, but a nurse inserted it in my cubital vein quickly, and I can’t say that it hurt.

I squeezed my stress ball to keep the blood flowing, had sips of water, and chatted with my cousin and the staff. As I watched the red fluid flowing from my vein to the bag, I didn’t feel faint, as I expected. I did have a weird sensation I can’t describe, which was probably psychological, but there wasn’t pain, sweating, dizziness or any other symptom I expected I would have due to my low blood pressure. It didn’t last more than five minutes, which is a lot quicker than I thought it would be. Even though I felt completely fine, I was advised to stay on the bed for a few more minutes just to rest.

After a friendly goodbye from the staff, and a present of a pen that looks like a syringe, I was shown to the cafeteria where I got a drink, a warm meal and a doughnut. I left the site feeling happy knowing my blood will help someone else, and elated with the enjoyableness of the experience.

For the rest of the day, I made sure to keep hydrated and have healthy meals, but otherwise I went about my usual business: I walked my dog, studied and went to the gym (exercise isn’t recommended straight after giving blood, but I was careful not to strain myself).

I realise that giving blood isn’t the first thing to pop into your mind when you imagine a perfect day, but it’s a quick and easy thing to do. It doesn’t take a lot of time and effort on your part, but it can make a big difference in someone’s life.
Find out more about donating blood, eligibility criteria, and how to get ready for a donation, with special notes for first time donors.

A few facts from the American Red Cross:

  • Every two seconds someone in the U.S. needs blood.
  • More than 41,000 blood donations are needed every day.
  • Although an estimated 38% of the U.S. population is eligible to donate, less than 10% actually do each year.

Give blood, save lives.

Featured Image:
Blood Donation Appointment in Calendar/Journal by Oliver Symens

Categories
General

Neurology and Us: What Are Our Minds?

As medical students, we have to take many classes. Some of them are relatively easy, and some of them are hard. One class notorious for being very difficult is neurology. Despite this, though, I find neurology to be one of the most fascinating subjects we study. Think about it: everything we call “us” arises somehow out of vast networks of interconnected neurons. It is mind-blowing to even begin to contemplate the complexity of the neuronal machinery responsible for such tasks as creating our thoughts, emotions, personalities, etc. etc.

For millennia, philosophers have been attempting to accurately describe what it is to be human without the aid of neuroscience. Only recently has neuroscience been added into the mix of this speculation; the first notable contribution of neuroscience to theories of mind appeared in 1949 as Donald Hebb’s book The Organization of Behavior. For the first time in a major publication, a neuroscientist postulated that it was possible for the purely physical processes of neuronal circuitry to explain psychological phenomena like states of mind and learning. Before the advent of neuroscience, learning was considered a psychological phenomenon, and any attempt to explain it in detail had no recourse to neurophysiology. Now, learning is taught in medical school curricula as at least partially due to changes in both presynaptic and postsynaptic neuron adaptations (changes in neurotransmitter release rate in the presynaptic neuron and long term potentiation in the postsynaptic neuron). This represents a paradigm shift in the way we think about ourselves. Is learning the only psychological phenomenon explainable by changes in neurotransmitter release and altered receptor densities? Are all aspects of our minds the result of nothing but extremely complex neuronal circuitry?

Proponents of a theory termed eliminative materialism believe all of the commonly held beliefs about our minds will soon be replaced by neurophysiological explanations at the level of neuron circuitry. As the Stanford Encyclopedia of Philosophy puts it in the entry on the philosophy of neuroscience:

“Eliminative materialism (EM) is the conjunction of two claims. First, our common sense ‘belief-desire’ conception of mental events and processes, our ‘folk psychology,’ is a false and misleading account of the causes of human behavior. Second, like other false conceptual frameworks from both folk theory and the history of science, it will be replaced by, rather than smoothly reduced or incorporated into, a future neuroscience. . . according to EM, continuing development in neuroscience will reveal that there are no such things as beliefs and desires as characterized by common sense.”

Will eliminative materialism turn out to be the correct account of our behavior? Who knows? The debate rages on. Neuroscience continues to uncover more physical processes underlying the way we experience the world, but competing theories claim the irreducibility of our experiences to mere materialistic phenomena. Even if I could, for example, fully explain the state of your nervous system down to the smallest detail after you learned of the passing of your loved one, does that mean I really know what you’re feeling? Does a specific brain state actually equate to an emotion as we experience it as conscious beings? I don’t know, that’s above my pay grade, but it’s fun to think about, isn’t it?

Source: Stanford Encyclopedia of Philosophy

Featured image:
object. by Evan

Categories
Disability Issues General Lifestyle

Deafness as a culture

“Try not to associate bodily defect with mental, my good friend, except for a solid reason”
– Charles Dickens, David Copperfield

What is the first thought that pops into your head when you think of the word deaf? Do you think of a disability? An inability to function in society? Do you think of loss? Of a deficiency in one of the most vital senses? Or do you think of group of people with similar values and beliefs, brought together through their experiences?

The medical model sees deafness as a disability, an impairment that needs to be fixed. A disability is defined in the Oxford Dictionary as a physical or mental condition that limits a person’s movements, senses or activities. In this sense, one could agree that deafness is considered a disability. However, deafness comes in two forms: deafness, indicating disability, and Deafness, indicating a culture.

Culture is defined as the ideas, customs, and social behaviors of a particular people or society. Deafness can therefore be viewed as a disability or an altered human experience. Deaf culture can include beliefs, behaviours, traditions, history, and values of the community. Deaf culture is an ethnocentric culture, based more upon sign language and relationships rather than a common native land – it is a global culture. Deaf Culture sees itself as a language minority than a disability.

 

Values and Beliefs

A culture tends to have its own beliefs and customs that are shared by its members, and deaf culture is no different. Deaf social protocol is based upon maintaining good visibility with others in the environment (Deaf Culture 2014).

Some examples of social customs within this culture include:

  • Rules of etiquette for getting attention and politely negotiating a signed environment
  • Keeping one another informed of what is going on in one’s environment – for example, letting someone know that one is going to the bathroom (in the hearing environment this is often not needed)

 

Arts and Literature

As with other cultures, deaf culture is rich in history and art. Storytelling also makes up a big part of the culture. Clayton Valli was an American deaf linguist who created works in ASL performed through handshape, movement and facial expression. One of his pieces of work, called Dandelion can be found here.

There is also a National Theatre of the Deaf in the USA that involves productions using ASL and spoken word. Their mission statement is to educate the public and open their eyes and ears to deaf culture (National Theatre of the Deaf 2014).

Media is a vital component in getting ones message heard, and many artistic groups throughout the world have increased awareness of deaf culture, helping to stem ignorance and begin a conversation about the experience of being deaf. Movies and TV programs also need to start promoting deafness not as a pathological condition but as a way of life, helping to banish this perception of disease and impairment.

 

Cochlear Implant Controversy

Cochlear implants are electronic devices that can be surgically implanted in patients who are deaf due to sensory hair cell damage. They can provide hearing in order to increase understanding of speech, and it is estimated that 324,000 people worldwide have received them as of 2012 (NIDCD 2013).
Although this may seem like an incredible treatment for those who have difficulty hearing, it also gives the suggestion that deafness is a condition that needs to be fixed. Some deaf people are not so much against the cochlear implant, than what it represents: a lack of respect for their culture. Indeed, some people have gone so far as to describe these devices as a means of cultural genocide.

It can be argued that deafness, as a cultural identity, should be encouraged to thrive and be supported in today’s diverse society. Others believe that every child should be given an equal chance in life. Through cochlear implants one will have opened the door to greater opportunities, such as better chances of finding employment, integrating with the community at large, and achieving a greater level of success. But why should a deviation from the norm result in fewer opportunities in the first place? Shouldn’t we be dealing with this inequality rather than trying to cover it?

Doctors may see a deaf child as missing something vital, being impaired and therefore not able to function in society. The word impairment implies fault; imagine the implications this can have on a child who is told they need to be fixed. Children should feel proud of who they are, not ashamed of what they were born with. What kind of impact would such thoughts have on their self-esteem? We all know how isolating it can feel to be different during childhood; why should we push these children further away from society?

Cochlear implants are seen as being oppressive: an illustration of our overreliance on the biomedical model. Instead of seeing a child as impaired, it would be more helpful to see the child as having a different natural language. We live in an age where we preach about acceptance and diversity. Shouldn’t we be embracing the deaf culture instead of annihilating it?

What does this mean about the future? If we find the cure for deafness tomorrow, does that eradicate an entire culture? Will there be people out there who will refuse to accept the cure for their child? And what implications will that have on the medical profession – can we accept this refusal? After all, every child deserves the best start in life. Where do we stand between respecting ones beliefs and doing the best for our patient?

 

Diversity

It has been suggested that deafness can be an isolating experience; you are part of a minority, cut off from the rest of the world. One could also argue that there are plenty of cultural minorities out there; despite English becoming more and more vital in our multicultural environment, there are many minor cultures out there who do not have English as their native tongue and are therefore cut off from a large part of civilization. Does that stop them from being a culture?

Diversity is a good thing: it is what makes society grow. It is needed for creativity, for quenching ignorance and progressing as a race. What is considered normal in this day and age? Having an illness gives you a new identity, a new way of looking at the world and translating your surroundings. What is considered illness to one person is considered normal to another. By embracing the different views on deafness, we embrace the diversity of mankind and what it has to offer.

 

References
Deaf Culture. 2014. Comparative chart: deaf and ethnic cultures [Accessed: 17thDecember 2014]
Deaf Cultural Centre. Arts & Culture [Accessed: 17th December 2014]
Jones, M.A. 2002. Deafness as Culture: A Psychosocial Perspective. Disability Studies Quarterly. 22:51-60
National Theatre of the Deaf. 2014. About the National Theatre of the Deaf [Accessed: 17th December 2014]

Featured image:
DEAF project #5 by Dario-Jacopo Lagana’

Categories
Clinical Reflection

Chronic Fatigue Syndrome

The year was 2011 and I was an undergraduate student at Weber State University in Ogden, Utah. I was on the premed track and looking for doctors to shadow and research to participate in. I was also working part time at a physical therapy clinic and one day I started a conversation with one of the patients. After hearing a little about my interests and career goals, she became enthusiastic about introducing me to her doctor who was conducting research on chronic fatigue syndrome.   I had never heard of the syndrome, but I was eager to take on any new medical experience and jumped at the opportunity. One week later I found myself at the clinic of Dr. Lucinda Bateman in Salt Lake City.

After meeting with Dr. Bateman and discussing chronic fatigue syndrome, I followed her throughout her day and sat in on several appointments. Because chronic fatigue syndrome is a relatively unknown condition, Dr. Bateman and her patients were strong advocates of educating as many people as possible about the condition, including me.

Many of the patients shared their stories with me. One woman I remember vividly: she was quite thin with short cropped hair and wore a smart business suit and trendy glasses. The immediate impression I had when I saw her was that she was someone who got things done. Her story was heartbreaking. I listened as she described her life before chronic fatigue syndrome and how she was a “go, go, go” person. She worked full time, ran long distance races, and was active in every sense of the word. Then, one day, she could not get out of bed. Her muscles ached intensely despite the fact that she had not exercised the day before. She was debilitated by an intense fatigue she could not overcome. These symptoms lasted for days before she scheduled an appointment with her primary care doctor. All the tests came back negative and she was prescribed bed rest, which did not resolve any of the fatigue or pain.

I could tell as she was recounting her story that she was trying not to become emotional. She was still experiencing the fatigue and recalling the activities she used to enjoy was difficult for her. I felt I could begin to understand some of what she was going through, because I could remember how cripplingly fatigued I had been when I had contracted infectious mononucleosis as a teenager.   I could not imagine having to deal with that kind of fatigue for months or years on end.

After shadowing Dr. Bateman, I went on to finish my undergraduate degree and was accepted into medical school. I heard nothing of chronic fatigue syndrome for years. In February, 2015 I was surprised to see that NPR had published an article on the syndrome. The article was written to cover a new report published by the Institute of Medicine. The report legitimizes chronic fatigue syndrome (known as myalgic encephalomyelitis in Europe), establishes  new diagnostic criteria  , encourages more research into pathophysiology and treatment, and recommends that the name of the disease be changed to Systemic Exertion Intolerance Disease (SEID).

According to the report, “between 836,000 and 2.5 million Americans suffer from myalgic encephalitis/chronic fatigue syndrome,” and the hallmark of the disease is “a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities, that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest.”

As we go through medical school and enter practice, I think it is a good idea to be on the lookout for these patients. I highly recommend reading the report for educational purposes, especially since, according to the report, less than one-third of medical schools educate their students about chronic fatigue syndrome and fewer than half of medical texts mention it. The disease is poorly understood, but increased awareness and future research may help fill in our knowledge gaps and assist in finding effective treatments for those who suffer from chronic fatigue syndrome.

Read the NPR article: “Panel Says Chronic Fatigue Syndrome Is A Disease, And Renames It”

Read the Institute of Medicine report “Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness”

Featured Image:
cfs by Jem Yoshioka

Categories
General

Call For Medical Student Writers

The Medical Student Press invites all current medical students to apply to join the MSPress Blog team. The MSPress Blog is a weekly publication featuring humorous, instructive, creative, and opinionated pieces.

Regular writers are required to submit one piece a month. To join the collaborative and expressive MSPress Blog team, visit our application site. CV and writing sample are required. For further information, feel free to contact the current MSPress Blog Associate Editor, Marija Kusulja (blog@themspress.org).

Categories
General Lifestyle Opinion

Staying Alive

https://www.youtube.com/watch?v=n5hP4DIBCEE

https://www.youtube.com/watch?v=ILxjxfB4zNk

Have you seen these videos that promote hands-only cardiopulmonary resuscitation (CPR)? Unfortunately, they don’t appear to be as popular and catchy as the song they feature.

CPR is a basic life supporting activity that literally saves lives. Even though the majority of the public is familiar with the concept or CPR, most don’t feel confident in executing it when the need arises. This could be because there are not enough first aid courses. However, I think there is another important factor for consideration.

Media and the entertainment industry, especially films and TV shows, portray physicians performing CPR as a miracle. The setting usually includes a gasping patient whose ECG suddenly flat-lines; then the doctors run in, yelling ‘blue code’, and immediately applies defibrillator pads on the patient’s chest. There may be sparks, and the patient is usually shown to give a jolt, often waking up and becoming completely alert and fully recovered.

Following this highly romanticized portrayal of CPR, it’s not a surprise if non-health professionals decide to merely wait for heroic EMTs, paramedics or physicians. In fact, some may view CPR as a seemingly complicated procedure that requires special equipment with the ability to bring a dead person back to life.

I don’t expect medical TV shows to be completely accurate or to portray entirely realistic situations; nevertheless, the repetitiveness of this false portrayal of resuscitation sticks in the minds of viewers. The entertainment industry is not responsible for educating the general public, but even if they don’t portray CPR entirely accurately, they shouldn’t lead their viewers astray. Repetitively being exposed to on-screen resuscitation, people can come to believe that defibrillators are an essential piece of equipment, without which resuscitation isn’t possible and the best approach is to leave it up to health professionals. Furthermore, showing conversion of flat-line ECG into sinus rhythm implies that electricity can restart a human heart. With the amazing automated external defibrillators becoming more widely used, a non-health professional can use them without knowing which rhythms are convertible, but I still believe they need to be aware that flat-line ECG means there is no electric activity in the heart, and that electricity cannot reinstate it; all a defibrillator can do is give a jolt to an irregularly paced heart which will hopefully terminate the irregular rhythm, allowing the natural pacemaker to take over and reinstate sinus rhythm.

The media has a strong influence on all of us. While attempting to amuse the audience and gain financial reward, the media should still impart important and accurate life lessons.  Thanks to TV series and films, I don’t expect anyone would struggle to remember the emergency telephone number. Yet, because of the same media influences, many people would wait for an ambulance and their magical defibrillator instead of starting CPR themselves. Instead of giving false impressions about resuscitation, the media could play a large role in popularizing CPR as a simple, but vital action that can be performed by anyone, anywhere. Even though it is not the point nor purpose of the entertainment industry, this is an important message that can be relayed without requiring producers and actors going out of their way.

Featured image:
cpr mother & child by zen Sutherland

Categories
Clinical Humour Lifestyle

A Guide to the Operating Room for Medical Students Or How I Learned to Stop Worrying and Love the Sterile Field

The summer between MS1 and MS2 I did a research project with an orthopedic surgeon at my school.  Part of the project had me observing in the operating room (OR) a few days a week, watching procedures and helping with any tasks that came up.  This experience was actually my first time being in an OR, and I was pretty nervous leading up to it.  I had heard horror stories about students breaking sterility, knocking over solution bottles, and generally making fools of themselves in front of important people.  While I tried my best not to do anything foolish or embarrassing, it was oftentimes very hard to avoid.  Slowly, I become more confident in the OR, and the blunders came further and further apart.  As a service to all the pre-meds and un-initiated med students, I now present a short list of important things to know before your first OR experience.

  1. Figure out the rules.  Surgeons love rules, and at times it seems as if they have a weird fascination with them.  If you don’t ask then the rules are never really explained to you, and you will be in big trouble when you break one.  Consequently, I think it’s prudent to ask someone what the rules are.  Considering your fear of talking to the surgeon, he or she isn’t the best option.  The resident or intern is probably too sleep-deprived and hopped-up on caffeine to notice you.  Your best bet is to ask one of the circulating nurses or other students who have been on the service for a while.  Believe me, it will save you a lot of trouble later on.
  2. Make sure you’re dressed appropriately.  Make sure everything you’re supposed to wear is on correctly.  Make a mental note of scrubs, cap, mask, and boots.  Aside from actually wearing the right attire, please make sure you are wearing it correctly.  You’re going to feel really stupid when someone points out that your cap is on crooked, or that you forgot to tie half of your mask.  You will also be the butt of many jokes over the next few days when you aren’t there.  In addition to knowing what to wear, it is also important to know what not to wear.  Don’t wear shoes that you actually like, unless you think it’s cool to have fecal matter on your $100 Sperry’s.  Also, leave the personal items and accessories at home.  While that puka shell necklace you made in 10th grade art class may be “totally rad, bro,” it is definitely a sterility hazard and you definitely shouldn’t bring it into the OR.  Also, if you’re still wearing puka shell necklaces in your mid-20s you should probably re-evaluate your life choices.
  3. Know where the sterile field is and how to avoid it.  This rule only applies if you’re not scrubbed in, and the decision of whether or not you get to scrub should have decided before you show up.  Anyway, just remember that the sterile field should be avoided like the plague.  Any blue towel or covering should send off warning signals in your head.  Don’t get close to it, don’t breathe on it, and don’t even really look at it if you don’t have to.  Don’t try to be cute either and inch your way as close as possible, because the scrub nurse will call you out and you will be embarrassed.
  4. Try to look interested even when you’re not.  After the 5th time seeing the same surgery, it’s only human nature to get a little disinterested.  There are only so many times you can be mystified by a hernia repair, and you’ve probably passed that threshold long ago.  It is imperative, however, that you look interested at all times.  Surgeons have an innate ability, almost like boredom-radar, to tell when you are dozing off or doing something else.  These situations usually end up in you getting pimped mercilessly in front of everyone.  To make matters worse, you don’t come off looking like a shining star when your response to the first question is “Huh?”  You can typically avoid these situations by employing certain maneuvers that indicate “interest.”  My go-to method was switching sides of the OR every 20 minutes to get a new “viewing-angle.”  Another tried and tested one is intently looking at the monitors or camera.  Find what method works for you, and stick to it.
  5. If you’re not scrubbed in, find yourself a role.  Surgeons dislike idle people.  There’s nothing worse you can do than to just stand in the same place in the OR doing nothing.  Find a job you can do, and be amazing at it.  Like to record information?  Write down the incision and closing times.  Like to clean?  Become the best darn disinfectant wipe user ever.  Like to retrieve things?  Be the person who looks up and prints all the obscure research papers the surgeon even tangentially mentions during the procedure.  Note:  If you choose the last one, be prepared for incessant pimping later.  Remember folks, nothing is without consequence, so choose your punishment wisely.
  6. Prepare yourself for the spectacle that is a patient waking-up post-op.  This is the part that you never hear about or even see on those dramatized TV shows about surgery.  A patient waking up from anesthesia is most definitely not pleasant.  Prepare yourselves for all sorts of near disasters.  Patients will try to pull out breathing tubes, or roll over onto joints that have just been operated on.  Some will even try to get out of the bed, as they don’t realize where they are for the first few minutes.  People will often kick out their arms and legs, and if they aren’t stabilized someone on the team is bound to get a black eye.  The best thing you can do is to be aware of the possibilities, and find out how the team handles such situations.
  7. Find a place to store food for post-op consumption.  We have finally reached the pinnacle, the crown jewel of my OR guide.  Don’t pay attention to the fact that this rule actually doesn’t correspond to anything taking place in the OR.  After spending countless hours in the OR, the first thing on your mind will be food.  No matter how mundane or exciting the procedure was, human need for nutritional sustenance will take over.  Make sure you have a safe storage spot for food, whether it is in the clinical workroom or in the students’ lounge.  Also, considering that everyone you will be working with (read: vultures) will also be voraciously hungry and will have no problem eating anything lying around, make sure you keep your food in a place only you can find it.  Invest in a locker and a lock if your facilities have them.  You’ll thank me for this advice later.  You’re welcome, by the way.

Featured image:
CPMC Surgery by Artur Bergman

Categories
Literature

Ishmael’s narrative: an emotional response

“Call me Ishmael” is the first line in Moby Dick and probably the most famous opening line in all of American Renaissance era literature. Taken in a different context: “Call me Ishmael,” or perhaps: “My name is Ishmael,” could also be a first exchange between a doctor and patient. Coincidentally, our Ishmael in Moby Dick tells readers something that resembles what a patient might say to a doctor following initial greetings:

moby dick
Photo courtesy of Tony Sun

[So doc,] Some years ago—never mind how long precisely—having little or no money in my purse, and nothing particular to interest me on shore, I thought I would sail about a little and see the watery part of the world. It is a way I have of driving off the spleen, and regulating the circulation…whenever my hypos get   such an upper hand of me, that it requires a strong moral principle to prevent me from deliberately stepping into the street, and methodically knocking people’s hats off—then, I account it high time to get to sea as soon as I can.

So, translation? That is to say, can a physician translate Ishmael’s opening account into a chief complaint and past medical history? Here is my attempt: Ishmael is a middle-aged male (his age is not given) who complains about feelings of boredom and tiredness. He also describes a history of behavioral symptoms that suggest underlying feelings of anger. Ishmael mentions he looks for ways of “driving off the spleen”—the most fitting definition of “spleen” given by the Oxford English Dictionary is: “irritable or peevish temper.” Imagine now, if a patient used that exact phrase, “driving off the spleen,” to describe his anger and how he tries to rid it. As a student, I encountered patients during my preceptorships that mentioned similar behavioral symptoms including becoming “more irritable” and “losing their temper.” I found it challenging but helpful to imagine such feelings and consider them in the context of the patient’s chief complaint and past medical history. This allowed me to move with the patient’s sorry and avoid awkward moments and responses. As an exaggerated example, responding with a huge smile to a patient saying they’re “irritable” is not an ideal reaction and creates a difficult situation. Many times, these problems may not even be apparent until later reflection. To give students more chances to reflect, some medical schools such as Weill Cornell Medical College offer students recorded sessions of them interviewing mock patients. As a student, taking complete patient histories is not an easy task, and we can use all the practice we can get.

To wrap the above discussion into the ongoing theme of my posts—how reading imaginative literature is useful to doctors and scientists—I would suggest that my classmates, and also upper years and residents, make time to read poems and imaginative fiction that elicit a wide range of emotions. To this end, I can give the example that reading Othello and King Lear elicits very different emotional responses than reading, say, A Midsummer Night’s Dream and As You Like It. Yes, readers should read deeply into the variety of emotions in these plays, but they must remember to feel those emotions within the characters of Othello and Lear, or in our case, Ishmael and Ahab. This reading followed by feeling is a practice that physicians can use while taking a patient history: read and hear the patients’ situation, and then feel with the patient. Importantly, students and doctors can practice this even outside the clinic, while reading a poem, play, or novel.

Coming back to Melville’s novel, Ishmael announces his decision to go on a whaling journey at the end of Chapter 1: “By reason of these things, then, the whaling voyage was welcome; the great flood-gates of the wonder-world swung open.” Ishmael’s decision to “get to sea” then brings readers into Ahab’s infamously mad pursuit of the white whale.

My future posts will follow Ishmael’s narrative and bring to light elements that relate to medicine and science.

 

Featuring image:
Sea and sky by Theophilos Papadopoulos