Well I finished my week and a half at Child Psych. In my last post I wrote a bit about that. I miss being there. My last day was Tuesday. So technically, I’ve been on the General Surgery service for three days now. But I didn’t go in on Wednesday (my third year was sick and told me not to go in). So I missed my first day on Gen Surg.

Yesterday I went and sat through an hour lecture by a neurosurgeon on Intracranial Metastatic Disease. I got to be the designated “next” guy — which means I sat with the keyboard and advanced the powerpoint slides for him. So I definitely didn’t want to fall asleep. At this point I still hadn’t met my third year, but I thought he was sitting in the back of the room (there were less than 15 people). He told me to meet him at the conference room for a lecture, but I hadn’t met him before we got started.

After the lecture I met the third year student I would be following for the next week and a half. He took me to the call room where I dropped off my bag and then we headed to the Minor Surgery section.

I saw a two masses removed from two different patients. I think they were sebaceous cysts, both located on the patients’ backs. The cut was pretty deep. From my point of view it looked like they cut down an inch deep.

Honestly, there was none of the excitement one generally ascribes to time spent on the General Surgery service. I have clinic today later at 1 PM, but I doubt I’ll see anything terribly exciting. I hope I get to scrub in on something next week…

*****

Yesterday, after I got home I found an email from one of the editors at Medscape - The Differential. The Differential is a group blog hosted at Medscape. And, I believe, Medscape is a part of WebMD… or closely associated with it?

Anyways, the email was asking if I would be interested in joining the group blog over there. I’ll let you know what happens with that. I’m considering joining if they offer. Although, from the looks of it, the blogs there are not-at-all anonymous. But then again, this blog isn’t very anonymous either…

I stood at the end of the hallway looking out through the large windows. Outside the sky was gray, the blacktop was damp, and the trees were dripping. It was a stark contrast to the interior. Here, where I stood, the walls were brightly colored, cartoonish faces squinted, frowned, and smiled, and random quotes encouraged readers to share and play nice.

Less than ten feet away from me a doctor was interviewing a patient. I’m not sure how the interview went. I wasn’t paying too much attention. I knew of this patient, though. The young pre-teen had been admitted because she had reported thoughts of killing herself. One might think that this bit of information might be betraying the patient’s identity. But sadly, many of the patients I have been seeing in the child psychiatry unit have/had suicidal ideations.

In a place like this, the patient population seems to have more in common with the dreary weather outside than the bright, cheerful surroundings inside. I’ve spent three days on the unit, and it has been — well, shocking. I have found it all quite interesting. I will definitely not cross Psychiatry off my “list.” But if I had to describe what I’ve seen in one word, that word would be “sad.”

When people hear that I am spending time in the Child Psychiatry unit, I often get asked if they patients look different. Maybe they think these patients have “crazy eyes” or some other telltale sign of craziness. If there are, then I certainly don’t know what the signs are. But to me, these patients look like any other child you might find playing in a schoolyard playground. Except that a number of them are very depressed. And they look sad. But if they were happy, I could picture them laughing and hanging from a jungle gym set or fast and high on a swing set. My point is that visually, these kids wouldn’t stand out if you put them in a lineup with other children.

Abuse is common, though. So are hallucinations — if I can call them that. I’m not sure what the doctors are calling them, but a number of the kids report seeing or hearing things others don’t see or hear. I guess the staff will need to determine if they are truly hallucinations. One patient sees demons at night. Another sees ghosts without any limbs. Others hear voices that tell them to hurt themselves or other people.

When I found out I had been assigned to psychiatry, I thought it would be really fun. I imagined having adult patients telling me outlandish stories that would make me laugh. Then I found out I was assigned to Child Psych. Most of the patients I’ve seen here have made me cringe. Their stories are heart wrenching. It was shocking for me to see some of the things I saw. And as far as the cases of abuse, I wondered, what kind of society do we live in that produces children so mentally damaged by physical, sexual, and emotional abuse?

I have about a week and a half left in Child Psych. I’m sure it’ll be memorable.

I’m really happy. The joy is just crazy. It might even be bordering on giddiness. Today I came out of the two and a half weeks of exams. Previously I posted our final exam schedule. All in all, there were thirteen exams spread out over that time period. Three of those were National Boards Subject Exams, two were practical exams (Anatomy and Neuroscience), and the rest were in-house finals.

So tonight I’m just excited to be done with all my exams. Although I’m wondering if tomorrow that excitement will be replaced with dread. Now I will just have to sit and wait for the scores to come back in.

Tomorrow, we have orientation for the final month of Freshman Ward’s Experience. I found out that I got assigned to Psychiatry for my first two weeks and then Surgery for the final two. I think I rated both of these in the top 5 on my list of preferences. I heard that for the end of the freshman year I would want a relatively easy rotation. So, psychiatry was my pick. Surgery was listed in the top 5 just for me to see what its like in the event I may one day choose to pursue it. But now, I’m a little regretful. People (namely, third years) have been telling me that its tiring and the schedule is hectic. And, as a first year, I probably won’t get much out of it anyways.

Anyways, now that finals are over, and I’m back on the wards, I hope I’ll be able to have some time to write a few more posts about how the year went and things like that. Maybe I’ll even post some of the experiences from these next four weeks seeing actual patients.

Okay, so I’m sitting here about to go to sleep when I get this urge to go check out Twitter.com. So its not a short visit. I already have an account there from way back when I was trying to stay updated on something. Anyhow, I decide to set it up so I can use it with my iPhone (yeah, got one 2 weeks ago).

Well now it works with my phone. So I can text a message and it shows up as an update right here on JeffreyMD.com. So next week as I walk into exams, I’ll twitter a little message like “We who are about to die, salute you” or something like that and it will show up on the right sidebar. Ms. Gross, if you’re reading this, you can be happy I did not forget all of my dates and quotes .

Oh, and it shows up on my facebook status too.

We’ll see if I keep this thing goin or not.

But, what I am saying is that this was a big waste of 20 minutes! I should be sleeping now so that I can wake up early and hit the books before I have to drive home (1.25 hours). As usual, the Friday before exams have no scheduled classes. I’m in a wedding this weekend, so I have to pick up my tuxedo.

Busy weekend.

As you can tell by my writing I’m a bit scatter-brained at the moment… Either that or my brain is not functioning properly because I need sleep!

Well I finally reached my 101st post. Unfortunately I can’t celebrate. It’s been really busy lately. I know my monthly post rate has plummeted recently. Hopefully that has an inverse relationship with my exam scores?

Anyways, this is the last week of lectures. I can’t believe the year is almost over. That’s right, it’s the last week of lectures for the first year! So right now I should be studying. The next two and a half weeks will be exams. Some quarter finals and a couple in-house cumulative finals and a few standardized exams. We are required to score in at least the 7th percentile in the standardized exams. And last year, for Physiology, that meant a score of approximately 60%.

Wish me luck. Or pray for me. Whichever you believe in. I’ve included a copy of my exam schedule below for any curious onlookers. (A few blocks are highlighted to indicate a recent change in schedule).

Last week, I attended a Memorial Service at my school. The service was held for all those who had donated their bodies for use in the anatomy labs. There were three schools in attendance (Schools of Medicine, Dentistry, and Allied Health).

A couple of musical numbers were performed by students and a handful of students volunteered to speak and express their appreciation. At the end of the ceremony I looked around and saw some wet eyes. It made me realize that donating one’s body is a sacrifice for the loved ones as well. These friends and relatives never got to bury a coffin. And they won’t. In a few weeks we will have our Gross Anatomy final exams and the school will proceed to cremate the bodies.

I’ve heard that some medical schools have ended anatomy dissections. If I remember correctly, UCSF School of Medicine no longer has students dissect in Anatomy lab. They have models that the students can come and look at.

Personally, I have long thought models are the way to go. I think a whole lot of Anatomy lab is wasted trying to pick away fat and and fascia. But once you get through all the fat and fascia, there are benefits to actually finding the Vagus nerve coursing through the thorax, or the recurrent laryngeal nerve coming through the tracheoesophageal groove. It’s not something easily forgotten after dissecting to find those structures.

So to those who have donated your bodies for science, to those who believed in education enough to sign over yourself, to the families who have waited over a year before getting closure in the form of ashes: Thank You.

I know it has been a while since I last wrote. Been a bit busy lately. And in my moments of downtime I’ve found myself doing a different type of writing. I’ve been writing some fiction. Mostly because it’s a bit therapeutic. Anyhow, back to Medical School related matters.

On Friday we had two guest lecturers for our two-hour session of a class called Understanding Your Patient. During the first hour, a professor spoke about understanding cultural differences among our patients. He primarily focused on the latino culture because there is a huge hispanic population in the local area. One thing he mentioned is that in general, the hispanic population would put up very little resistance when talking to a physician. But that does not give any indication that they agree with what you are saying to them.

And that is a very important thing. In this class we have discussed the idea of getting a patient to cooperate and accept the treatment plan. And this applies to everyone, not just the latino community. In order to have the best results, doctors must team up with the patient for a common goal. The idea of white-coat-wearing-doctor dishing out his wisdom on health and a patient obediently following instructions is outdated and just doesn’t work.

During the second hour he gave the time to a local Mexican woman who talked to us about various herbal and traditional remedies the Mexican people use. She told us that many times they turn to those first, because going to see a doctor is just too expensive. She also brought samples of the things she talked about.

I learned that they use a camomile and spearmint tea for a of different things. She shared remedies for many common ailments. There is one treatment, for headaches, that I plan to try. It involves soaking a pinto bean in rubbing alcohol. In the event a headache, the bean is placed on the temples. Supposedly this relieves the pain. I’m quite interested in trying it out. Cause every once in a while, when I don’t drink enough water, I get some pretty annoying headaches.

Anyways, I hope to be able to post with a little more frequency this month.

P.S.
Remember the disclaimer. I’m not offering medical advice on this site. So try that pinto bean thing at your own discretion.

It’s getting busy now. It must seem like I say that a lot on my posts. At least I feel like I write that a lot. But its once again the week before exams. The lecture schedule is tapering off. We have only 3 lectures on Thursday (as opposed to the normal 4) and then no lectures at all on Friday.

I’ve been posting less in the past 2 months. It was an attempt to cut out some distractions. Although I do enjoy writing here and it can be, at times, quite therapeutic. But as it goes, school comes first. After all, I would have nothing to blog about if I don’t pass the year. And JeffreyMD.com would no longer make any sense. Cause I’m not planning to move to Maryland anytime soon.

Even now, I should be studying. I’m sitting here writing this post in the library. But I saw something in here that looked out of place. It looked so out of place that I actually found an excuse to walk by the aisle a second time to get another look.

I saw someone sleeping in the library! No, this was not the normal exhausted looking medical student. This was an older woman. And she wasn’t sitting at a desk either. She was sitting in a chair placed in the middle of an aisle of books. She took up the whole aisle. You couldn’t get by her.

I suppose one might think she was a student. But something tells me otherwise. She didn’t look that clean. Behind her chair there was what looked like a small piece of luggage. In front of her was some push cart filled with her things. I couldn’t get a good look at what exactly was in there. It just struck me as an odd sight to see.

I don’t want to assume she is homeless. But I’m afraid I’ve already done so. That may be a by-product of living within 20 minutes of downtown Los Angeles where I have often seen homeless people going around with a suitcase. Regardless, she does not look like a student. And, technically, I don’t believe non-students are supposed to be in the campus library.

I attend a university whose motto is “to continue the healing and teaching ministry of Jesus Christ — to make man whole.” Is her presence in the library a lapse in our security? Or are they intentionally allowing her to escape the nasty heat outside and sit a while in the cool of the library’s basement where she is no bother to anyone. She really isn’t in the way, even if you can’t get at the books she is sleeping in front of. She’s in a part of the library that hardly has any traffic anyways.

I wonder if I, hoping to one day become a good, Christian, physician should have gone up to talk to her. From the little experience I have had in life, I know that every one has a story to tell. Maybe she would have been grateful for it. But maybe she would’ve been annoyed at being woken up. I know I don’t like that.

Well, as the title implies, this was just a random post. I really don’t have anything to write about except that which I already have. It’s possible I’m just avoiding my physiology notes right now…

So with that, it’s off to Physio-Land to study the hormonal miracle of life!

Everyone loves February. It’s the cute little month with only 28 days (most of the time). And it also has that special holiday, Valentine’s Day. But someone also referred to it as Singles Awareness Day. So I guess there’s a mixed audience when it comes to that day.

This month I also had a couple of hours of lectures covering topics like sexual relationships with patients, dating, marriage, and adultery. Those are the ones I can think of right now but I don’t think I’m missing any February-related topics.

The class where we learned about sexual relationships — I think the lecture was titled “Sexual Boundaries” — was called Understanding Your Patient. The course director is a practicing psychiatrist. I’ll sheepishly admit that I would probably have a hard time explaining what that class is all about. At least not very succinctly. Listing some of the other topics discussed in that class might help paint the picture, though. We’ve talked about how to partner with our patients with a goal of better healthcare (as opposed to giving orders). We’ve discussed breaking bad news to patients. We’ve talked about aging and the difficulties associated with it. We’ve also talked about child abuse, red flags that we might encounter, and the responsibility to report our suspicions to the appropriate higher-ups.

We spent two whole hours talking about sexual boundaries. The take home message for those two hours? Don’t have sex with your patients.

We heard about doctors having their license taken away for getting involved with their patients. We learned that psychiatrists, because of the intimate nature of their work, can never get involved with their patients. A surgeon, who after operating on a patient, may be able to date the patient as long as number of years has passed. I guess the point was that “they” don’t want a physician to abuse his or her “power differential.”

A few days later, in a religion class called “Wholeness for Physicians,” we were talking about adultery. The instructor, who is a practicing psychologist, warned us that it is very easy for physicians to go down this path. Doctors at work, he told us, are constantly being attended to by the nurses. There is a very friendly relationship there (hopefully). And when the doctor goes home, he or she hears, “Honey, I’m tired. Watch the kids.”

Eventually the doctor begins to compare the spouse with the attractive young nurse. It can be a recipe for disaster. I think I understand the dynamics now.

So that was my experience during the month of love. That was the extent of my foray into anything close to relationship or romance — I listened to lectures about it.

Last year CNN ran an article written by Emily Breidbart, then a second year medical student. It’s an interesting read. At times I do feel that it is a struggle to protect my own idealism. But maybe she is doing a better job than I. Because I’ll admit, at times I find myself downright cynical — even comically cynical. But that’s another story. Anyways, in her article, Emily writes about how her curriculum, at times, seems to revolve around preventing lawsuits than the patient’s health.

Fortunately, this hasn’t been the case for me at my school during my first year. I think there has been the occasional mention of the litigious nature of the profession. And I think we (as students) have all heard plenty of stories about it. So it isn’t like we are ignoring malpractice. I’d say that they, and by they I mean the professors who teach us, choose to focus on the patient.

Who knows? Maybe one day Loma Linda’s curriculum will have to change. Maybe someday they will have to place the fear of litigation into the heart of every incoming first year. I hope not, though. Because a society in which doctors are afraid to treat patients is a society in trouble.

Oh, and check out Emily’s article “Med student struggles to preserve her idealism” over at CNN.com.