Ramblings on healthcare, medical education, and life with a spinal cord injury
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Category — medical school

Made it to Grand Rounds

Just a brief post to note that my recent story regarding almost cursing out an attending was selected for inclusion in this week’s Grand Rounds! For those unfamiliar, Grand Rounds is a weekly selection of the top medical/healthcare-related blog posts. Each week, it is hosted by a different blog and the host for that week picks out the stories. This week, it’s hosted by Doctor Fizzy, who publishes A Cartoon Guide to Becoming a Doctor. I’ve been enjoying her humorous cartoons for a while now, and if you’ve any association with healthcare you’ll probably crack up at them.

So thanks, Doctor Fizzy! Incidentally, this grand rounds was a lot more exciting than the ones we have to attend at school, which require our presence prior to 8am! Can you believe it? How rude!

July 6, 2011   No Comments

Just One Teensy Step

Two days ago, I took a huge step forward. No, not that kind of step this time. A metaphorical one. One of the major rites of passage in medical school is taking the first part of the US Medical Licensing Exam, or USMLE, as it’s cleverly known. The test is administered over the course of several years in three sittings, known sequentially as Step 1, Step 2 and Step 3, and taken after second year of medical school, during fourth year, and during the first year of residency, respectively. Medical students tend to refer to this first part as “Step 1,” or “boards” or “that $*#^% test.” I’ll just stick with “Step 1″ for now, this being a family kind of place and all.

One must pass all three in order to apply for a medical license in most states, I believe. Step 1 is an eight-hour marathon of questions. There are seven sections, each containing 46 multiple-choice questions and lasting one hour. You get 45 minutes of break time, plus a 15 minute tutorial that you can skip and add to your day, thus providing 60 minutes of break time to allot as one sees fit. And any time you have remaining when finishing each one-hour question block is also added to your break time. Take three sections back-to-back, then a full hour off, then four sections back-to-back if you like. Or take all seven straight through and be done in seven hours if it’s your preference. Based on solid advice from a good friend, I brought plenty of caffeinated beverages, fruit, snacks and a small lunch. Way too much, but better safe than sorry. Rather than one huge break, I took 5-10 minutes between every section with a bit longer for lunch and just tried to maintain a steady pace all day long.

It’s hard to overestimate the stress that this singular exam can put on students, and it’s important to keep one’s mental state in check. Yes, residency program directors do look at Step 1 scores as an initial guideline for who to invite for interviews. And it’s one of the biggest single components of a residency application. But of course, it’s not the only part. We were given eight weeks of time to prepare ourselves and even at the end, there’s always something more you could have studied. One more time to have gone over the microbio notes. One more time to review pharm. Just once more, I need to look at Wegener’s granulomatosis.

But it’s ok, because no matter how hard you study for this beast, there’s always just a little more that could be done. And what’s interesting is, I’m okay with that now. This is drastically different from when I took the MCAT five years ago. I left that test freaked out, thinking I should have cancelled my test right then and there because I was in such a daze that I was sure I’d bombed it. Well it turns out I didn’t bomb it, so I’m glad I didn’t cancel my score.

This time I didn’t even feel that urge to cancel it or feel overcome with concern. It was a test I’d known about as being a gargantuan stepping stone since long before I applied to medical school, and one which I’d been concerned I’d approach with great trepidation. But none of that was present. I just felt…relieved. Relieved to know I was done. Relieved to know that I’d spent as much time as my sanity would allow preparing. Relieved to know that I’d worked hard to get to that point. Relieved to know it was time to get my life back.

Phew.

June 26, 2011   No Comments

Memorializing a Gift in Death

One of the quintessential medical school experiences is gross anatomy. It’s one of the things people frequently ask about, and it’s possibly the one single experience that causes the most apprehension amongst newly-minted students. That first exposure to a cadaver is one that nobody will ever forget. Unzipping the protective vinyl bag, curling back the large sheets of plastic, and being confronted with the somewhat rubbery skin of somebody’s embalmed remains is at once both intimidating and awe-inspiring.

We’re first instructed to locate structures that can be felt externally, which begins to ease the transition to an increased comfort with the person who will teach us most about the structure of the human body. Feeling skin and bony structures, cool to the touch, is a good way to start. Eventually we must pick up a scalpel and make the first incision, opening the layers of skin that, up until now, have been all many of us have had any kind of close contact with on another human being.

Stories often circulate of the occasional student passing out upon their first experience in gross. Others may become light-headed or need to take a break. It goes to show how significant this experience is in the many rites of passage in medical school. Nobody in our lab fainted, although I’m sure there was some apprehension that was not vocalized – we were all new to each other at that point in the year, and I’m sure some were guarded.

Often, the apprehension that precedes one’s first foray into the gross lab is gone shortly after that first experience. Replaced instead by a growing familiarity and sense of purpose, and the realization that there is nothing to be intimidated by. Our purpose is clear: we are there to learn, and that is what we do as time goes on.

While we are told the age and cause of death of these, our first patients, we are not told their names. The process is intended to be anonymous, to ensure the respect and dignity due the donors and their families. So instead, many students name the cadavers. These were people who led full lives, and giving them a name, rather than just saying “our body,” helps to make the whole process more personal. These aren’t animals or science experiments we’re peering into, they’re people. I’ve worked in two separate anatomy groups, in different classes, and have learned a great deal from both Alfred and Herman.

Along with the names sometimes come stories of the lives people led. Alfred had tattoos that appeared to be of a military origin, so given his age, we came up with stories of him flying planes in the Korean War. And things he had done since then. Alfred led a good life, was a good man, and had some incredible experiences.

A few days ago, Case held a memorial service for the families and friends of those who donated their bodies to our education. These were people who chose not to be buried or cremated, but instead to have their remains preserved and then torn apart by young, eager students. People who, even in death, have continued to give. One can only imagine that in order to bequeath such a donation, the donor must have been incredibly selfless.

Despite looming end-of-year and board exams, a lot of the students came to the service to honor and remember those who had died, and convey our gratitude to the loved ones who were not able to bury those they cared so much for. Seeing those people, after spending an entire year in the lab, was truly stirring. If those who lay on our tables had not been real enough before, they could not be more so now. The lives of those we memorialized had ended, but their spirit continues to live on, through the people they loved, and now, through us and through every patient we will be able to treat because of what we learned from them. Seeing the attendants of the service was every bit as memorable and humbling as that first step into the lab. Probably even more so.

As my first year of medical school draws to a close, I think back on how much I have learned scrutinizing Alfred and Herman. This experience is neither replaceable nor quantifiable. Every time I locate the anterior scalene, palpate the sternal angle, examine a radiograph, or dissect the connective tissue around a mass or vessel, it will only be possible because of what I have learned and practiced in gross. Every patient I treat, every student I teach, every patient those people treat, and so forth. It quickly becomes clear just how exponential the reach becomes.

So to Alfred, Herman, every other anatomical donor, and all of those who have sacrificed so that we may learn, I thank you with all my being. In death, you continue to live on and have single-handedly touched and benefited more lives than any of us could ever imagine.

May 18, 2010   1 Comment