Friday, February 29, 2008

Spring Break!

It's finally Friday, and I am going home for spring break. The rest of this week has been pretty slow. I usually have a clinical correlation or some other clinic thing on Wednesdays, but this week there wasn't one. Not that I could go home early, mind you, because I had to hang around until 4 PM to meet with my advisor about my portfolio. I had brought books with me to study, so it wasn't a waste of time, but I felt kind of grumpy about it anyway when everyone else took off on Wednesday afternoon and I couldn't. The actual meeting didn't make me feel much better, considering that the changes my advisor wants are pretty picky and don't really relate to the content of my essay. Even so, it will still take me a few hours to get them all done.

We got out extra early today because there was no POD, so that was a plus. The cardiac surgeon I shadowed last summer was supposed to lead one of our seminars today, but he wasn't able to get out of the OR. So the cardiologist who is in charge of this block did the best he could to lead the surgeon's seminar, but it was kind of rough going since a lot of the slides weren't labeled and he doesn't know all of that surgery stuff anyway.

I'm on vacation all next week, and I'll be back the second week of March.

Tuesday, February 26, 2008

YOU: The FCM Attendee

Finally, we have reached our last week before break. It felt like this week would never come, but it is a pretty easy week since we have seen most of the material before. We are covering hypertension and vascular disease. Yesterday, we had a seminar on metabolic syndrome that was really funny. We had been asked to read an article about metabolic syndrome that argues against the existence of metabolic syndrome. The doc who led the seminar is one of the endocrinology block leaders. He's really cool. Anyway, I'm not sure if I left this seminar having more understanding of metabolic syndrome or less, but it was an entertaining seminar anyway. The second seminar on hypertension wasn't bad, but there's just no competition with the first one in terms of the entertainment value.

This morning, we had anatomy lab to go over lung embryology and neck anatomy. I really like that we're doing these anatomy labs this year. Even going over all those stupid neck triangles wasn't so bad now that we've seen them once before. We didn't have any small groups for FCM today, just a speaker presenting, so about half of my classmates decided to bail. That was too bad for them, because the speaker was Dr. Roizen, who gave us all free copies of two of his books. Since there were so few of us there, most of us got a copy of both books. He signed them all for us, too. You can never have too many free books as far as I'm concerned. If you're not familiar with Dr. Roizen's "YOU" books, they're really cute cartoon books that explain medical concepts to laypeople. Even though I already know most of the info in them, they're still fun to read.

I had clinic this afternoon, but it was a slow day. I did see one of my regular patients, a diabetic who comes in for checkups every couple of months. The weather still sucks. It's amazing how many days we can go in a row without seeing the sun in Cleveland. I will never understand what made someone decide that this was a good place to build a city.

Friday, February 22, 2008

I Heart the Heart

I turned in my portfolio yesterday. This is the last formative portfolio that we have to do this year. We have the same nine competencies that we had last year, but there are new standards for each competency that are specific to second year. For example, in research one of the standards is "Applies principles and skills in medical biostatistics and clinical epidemiology to analysis of data." We weren't required to address the specific standards for each competency, but I did it anyway so that all I have to do in April is just update my evidence. If any of you first years are reading this blog entry, you should do the same thing for your last formative too. Trust me on this.

We're back to doing cardio this week, and the seminars have been much better than last week. On Tuesday, we went to the Vascular Lab, where there were four different stations. Two were demos of ultrasounds and the pulse volume recording of a patient whose leg vessels were mostly blocked. Those stations were ok. We also had a nutrition station that was just ridiculous. First we waited around for the doctor for that station to show up. Once he got there, he gave an introduction and then invited the nutritionist to speak, but she didn't get to say more than one or two sentences before we were told to rotate on to the next station. I was kind of annoyed, because nutrition is an important topic, and we got no coverage of it whatsoever. The last station was the best. There was a patient who had familial hypercholesterolemia, which is a disease where the person is missing the receptors for LDL (the bad cholesterol). She had xanthomas in her Achilles tendons due to cholesterol depositing there, so the tendons were incredibly thick. Even I could tell that those tendons weren't normal! I had clinic in the afternoon, and everyone was in a bad mood, including me. Fortunately, my preceptor and I got out early because the 4:00 patient no-showed.

On Wednesday, we went to the Cardiology Exercise Stress Lab, where we saw a patient undergoing a stress test. I took one of these stress tests last year, and it's really hard even when you're young and relatively healthy. This patient was neither of the above, and the test had to be stopped early because the patient started getting some angina (chest pain). We also went over echocardiography and angiograms. It was a pretty good seminar. In the afternoon, we had a really awesome Clinical Correlation, one of the best that we've had all year. First, the cardiology pharmacist came and gave us an hour-long talk about the cardio drugs that he wasn't going to have time to cover on Friday. He is one of the best pharm seminar leaders if not the best, and his talk was really good. Then we had a second talk about coronary catheters and invasive cardiac monitoring, which was also excellent. After that we went and saw a few patients in the coronary intensive care unit (CICU). Overall it was a really long day, and I was tired at the end, but it was a good day.

Today we had the rest of the cardio pharm and then another one of those pointless POD small group discussions. Last week's POD small group discussion was surprisingly pretty good. Only three of the eight of us showed up, and we worked on the project like we were supposed to and even came up with some good ideas. It was almost actually fun. In comparison, this week's session was pure torture. That's about all I can say about it.

Monday, February 18, 2008

Seminars in Solitude

Last Friday's seminar was on the cell biology of atherosclerosis, and only about six or eight of us showed up. I felt bad for the speaker, but the course leaders probably should replace this seminar with something else next year since we've covered this material several times already. At least the assigned reading was decent. Also, our PBL patient died again. I knew he was in trouble since we spent all of last week learning about things like ventilators and living wills, but I still hate it when they die. I can't even imagine how I'm going to feel the first time a real patient dies on my service next year.

Today's seminars were not much more cheerful. They were about end of life issues from a philosophical or social perspective, and it felt an awful lot like an extra FCM session. To say that these seminars did not go over well with my class is a huge understatement. Some people were actually walking out in the middle. Ouch. The atherosclerosis seminar last Friday might have been repetitive, but my feeling is that it never hurts to review important concepts like atherosclerosis. It wasn't very easy to find much redeeming in today's seminars though. Some of the readings were helpful, but the seminars themselves were pretty painful. Hopefully they will be cut out of the curriculum next year also.

This afternoon, I participated in a pharmacology thread focus group. This meeting was similar to the focus groups that are held for each of the organ blocks, only it was for the entire pharm thread for both first and second years. As much as I like pharmacology and most of the pharmacists who teach us, the pharm thread is definitely not the greatest strength of CCLCM's curriculum. I think we made some very good suggestions to the thread leader, and hopefully future classes will have a better pharm experience than we did.

Our second formative portfolios are due this Thursday, and I'm going to be spending the rest of this week finishing mine up. Other than that, there is not much excitement at the moment. The weather is still completely gross. I can't wait for spring break.

Wednesday, February 13, 2008

The Art of Breathing

Monday's seminar was about breathing control, and it was ok. Our seminar yesterday was a review of acid-base physiology by the same anesthesiologist who taught us acid-base last year. This guy is really cool, and his seminars are always good. I also had clinic yesterday afternoon, but nothing exciting happened this week. (Not that this is a bad thing!)

Today we had a communications class, which wound up being pretty funny. It was about establishing boundaries with patients. I went first in my group, and my standardized patient was asking me questions about another patient. Of course, I didn't know this person he was asking about, and I didn't realize that I was supposed to pretend to know the other patient but refuse to give out any info about him. So every time the patient asked me about the other guy, I kept responding that I didn't know the patient he was asking about. At the end, the preceptors told me that I was supposed to know the other patient. Oops. It didn't say anything about that in the write-up of the patient scenario that we read before seeing our "patients." Hopefully I didn't frustrate the standardized patient too much. :-P

Our communication session ran over time, which made my group late for our clinical correlation to learn about mechanical ventilators. This was kind of interesting, but I think it could have taken about half the time it took. They had us go to a few stations where we learned about the different modes of using ventilators to assist patient respiration. We also saw some patients on ventilators. I'm not sure I still really understand all of the breathing modes based on the wave forms (there are dozens, maybe hundreds of them in all), but the engineers in my group were sure loving this stuff. At one station, they had us try breathing using two of the different respirator modes (pressure versus volume) ourselves. It was surprisingly uncomfortable, as well as difficult, to time my own respirations with the machine's. Now I understand why patients on ventilators often have to be sedated.

Friday, February 08, 2008

Lung Cancer and Laryngitis

This has been a rough week, and I have really been dragging. It felt like Friday would never come. I still don't completely have my voice back even now, but the cough is a lot better. I can talk a little bit as long as I talk softly.

Wednesday was a really long day. I had PBL and a lung cancer path seminar in the morning, then a pulmonary hypertension clinic in the afternoon. That clinic wasn't as good as most of the other special clinics we have done. But I'm not sure how much of it was just that I wasn't feeling the greatest. I think maybe the engineer types liked it, because there was a lot of talk about the pumps used to treat people with chronic pulmonary hypertension. I have to admit that even when I'm feeling well, that kind of stuff really doesn't interest me. :-P In the evening, there was a Dean's Dinner at the Foundation House for my class. Only about half a dozen of my classmates showed up, which is pretty embarrassing. Plus, now the administration is probably going to cancel our spring Dean's Dinner due to lack of student interest, which kind of makes me mad. I really like going to the Dean's Dinners. Anyway, the talk and the dinner were both awesome, and I'm glad that I went.

This afternoon after POD, I had my first acute care clinic. I got lost in the hospital and ended up meeting my preceptor half an hour late. But he was cool about it, and the patient I had was really awesome. I did a complete history and physical on her and went through the steps of getting her admitted to the hospital. She was a woman who came from a rural area and did a lot of chores. When I asked her what the chief complaint was, she said that she was getting short of breath. Then I asked her what she had been doing at the time that she noticed the shortness of breath, and she said that she was chopping wood with an ax. I was thinking that I probably would get out of breath from chopping wood with an ax too, and I'm a lot younger than she is!

Later tonight, I am going to one of the first year's house for dinner. But I am going to take a nap for an hour first, because right now I am just drained.

Tuesday, February 05, 2008

Lung Infections

When I went to the doctor last Friday, part of the workup involved sticking a Q-tip up my nose to swab for influenza A. Sure enough, it came back positive--I really did get the flu. Talk about bad luck. On the bright side, I'm feeling a lot better now, and I don't have a fever any more. I just don't have any voice--none whatsoever. That made for a pretty hilarious PBL session yesterday. My group tends to be pretty rowdy, and sometimes it's hard to get a word in edgewise. Well, I was in no condition to duke it out with anyone, but my group members were awesome. Whenever I tried to whisper anything, the rest of the group would just stop talking. I don't think I've ever been this nicely accomodated in PBL when I wanted to say something! I had to leave a few times for uncontrollable coughing fits, but otherwise, the session was great. Ironically, the case this week is entitled, "Another Cough," and our seminars yesterday and today have been about lung infections. Here I am, continuing my class's pattern of someone coming down ill with the pathology of the week. I'm just glad that I didn't get sick at the end of the week, when we're going to be covering lung cancer. :-P

I went to clinic this afternoon, and my preceptor was sick too. The weather is still lousy, but all of the patients showed up except one of the 4 o' clocks. So we got done right at 5:00, and we mutually agreed to go home early and review my patient logs next week. I can't even imagine what the patients must have been thinking when we came into their rooms. First, I'd come in alone and get their histories in a whisper. I'd have to hold my own breath when I listened to their hearts so that I could actually hear anything. Then, my preceptor would come in with me, and the two of us would be examining the patient in between coughing fits. We were both way sicker than any of the patients we saw were. This just supports something I read once about how the worst place to be when you're sick is in the hospital. Why? Because that's where all the germs are.

Friday, February 01, 2008

Double Dose of Dentists and Doctors

I have had a pretty sucky past two days, maybe the worst since I started medical school. Where to start....Ok, about a week ago, I began having a toothache. Normally, I get my dental care when I go home to visit my parents during breaks. I've been going to that same dentist for a long time, and I only have to go once every six months, so why go try to find someone new in Cleveland? But this was an emergency, because we don't have another break until March, and I didn't think I could last for a month. I checked my health insurance plan, and it turns out that we do have dental coverage through the Case dental school. They'll even do regular cleanings for us every six months, and it's all covered. I managed to get myself an emergency appointment for yesterday morning.

The Case dental school is a pretty impressive setup. They've got a bunch of huge clinics in there, and the upperclassmen dental students work on patients with their preceptors. I wasn't 100% thrilled about being worked on by a student, but it's not like I can really complain. I mean, my patients let me poke and prod them in clinic all the time, so I'm really not in a position to say that I don't want to be a learning experience for a dental student. Plus, my tooth was really hurting, and I think I'd have just about let someone use rusty pliers on me by that point.

The student I got was very nice and obviously was trying her best. But she was slow, slow, slow, and she didn't do a very good job with freezing my mouth. She basically froze everywhere except the gum by the tooth she was drilling. So I had no feeling in my tongue, lips, or face on that whole side, but boy, I sure felt her drilling me! There was no way I was going to let her remove all of her torture contraptions, reinject me, and start over again though, so I told her to just keep going as fast as she could, and I'd do my best not to jump. I was pretty white-knuckled and had tears streaming out of my eyes, but we got through the drilling and she filled the tooth. So three hours later, the problem was solved, even if it wasn't the most pleasant experience during the actual procedure. (It took three hours because every time she did something, she had to get one of her preceptors to come take a look before she went on to the next part of the procedure. We also had to repeat the x-rays because the first set she got weren't right.) After that, I went home to chill a little.

I had woken up yesterday morning with a sore throat, but it was starting to get worse by last night. Then I started running a 102 degree temperature and coughing up a storm. So I emailed my learning objective to my PBL group and let them all know that I wouldn't be coming in today. I almost never stay home from school, and this is the first time I've ever missed a PBL session except for when I was away at that conference last fall. I didn't want to miss school today, but it turned out to be good that I did, because this morning I started vomiting too. In the afternoon, I got one of my classmates to drive me over to school, and I went to get checked by one of the docs in the clinic where I work on Tuesdays. My preceptor wasn't in today, but one of the other docs was. She told me that I probably had the flu. What!!! That is SO unfair! I got a vaccination last fall, and I still got the flu! It's actually possible for that to happen though, because the flu vaccine manufacturers have to guess which strains are going to be prevalent based on last year's strains, and sometimes they guess wrong. Lucky me.

On the bright side, the doc prescribed codeine to control my cough. I was a little nervous about taking it at first, because I still felt pretty nauseated, and nausea and vomiting are two side effects of narcotics. So I tried taking a half-dose, and it worked pretty well. I think I'll probably be ok with taking a full dose. Codeine is a highly effective cough suppressant. I was able to fall asleep for a few hours earlier this evening without hacking up half a lung. I still can't talk though without going into a coughing spasm, even with the codeine.

After the doc gave me the prescription, I went to get the codeine at one of the Cleveland Clinic pharmacies. While I was waiting for the pharmacists to make it up for me, I was sitting in a chair next to a large candy display. What a racket. I bet they sell way more candy than drugs in there. Every, and I do mean EVERY, kid who walked into that pharmacy with their parent made a beeline for that candy rack. It didn't matter if the kid was a toddler or a teenager. The same scenario then played out over and over again. First, the kid would ask for candy. The parent would say no. Then the kid would ask again, grab some candy, take it up to the line with the parent waiting. Nearly every parent eventually gave in and bought the candy for the kid after saying no multiple times. One guy who was there with his young son was the only parent who didn't cave in, not counting a second guy who carried his kicking, screaming daughter out of the pharmacy after refusing to buy her a piece of candy. All I could think was that if I had behaved like one of those kids, my parents sure wouldn't have rewarded me for being disobedient by buying me a piece of candy!