Readiness

I took a sample midterm today.

It was a strange feeling for me to totally bomb something like this. I'm glad that it doesn't count for anything, but I totally expected to flunk it anyway. I stopped studying for close to a month and I only started getting back into the groove of studying again about a week ago. My interest in the GI subunit was near zilch and even though I tried studying at school in the beginning, I didn't feel like I had the support of my fellow classmates. I started studying at home more often, which to be quite honest, was more like staying at home more often. I nearly doubled the amount of sleep I was getting a night, but I felt less rested than before. With my interest waning, my mood depressed and my short attention span, I found myself attracted to watching episodes of Scrubs on the internet. I would spend hours, watching episode after episode and pretend that it was somehow "helping me study."

Ha! I should have seen the warning signs earlier. I didn't turn to my friends at school for help. I had a difficult time even talking about it with my parents, who must have assumed that I was staying up late studying and that I must have been waking up in time for my classes.

In any case, I was not ready to take the anatomy and pathology exam today. I studied a little bit last night, which felt awfully productive to me at the time -- but I still got nearly all the questions wrong on the test. I felt like studying was just a waste of my time... which is a total shame. Yes, I felt ashamed for sure.

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We have a second portion of our midterm online which we can take up until Friday. I wanted to study for that tonight, but my fellow classmate (and small group tutorial buddy) was celebrating his birthday. I carpooled with some people over to Mai Tais tonight and I planned to stay there for just a few hours, but that turned into a whole evening when a bomb threat canceled Sarah's other evening plans and I said "sure, we can hang out here longer." I wanted to be ready when I took the essay and multiple choice questions; everyone who had taken it said that it was a waste of time to study for it because it was just so weird and different from what they had expected.

I spent about half an hour fidgeting and wondering if I should just walk back to campus. I overheard Josh saying "I don't feel well, I think I'm going to go home soon." Kapua frowned playfully and called him a party-pooper. I kept an eye on him, wondering when he was planning on leaving... when he suddenly started falling down.

I grabbed him as his knees buckled and his eyes rolled up. "Josh, Josh, are you ok?" He said that he wasn't feeling well. That seemed pretty obvious to me when he had collapsed at a busy bar, nearly knocking a few people over. He stood up and promptly fainted again, this time, hitting his head on the side of the bar with a loud "THUNK."

He regained consciousness shortly after that and a bunch of us escorted him outside, where he was given water, juice, crackers and his vital signs were assessed. He was pale, sweaty and somewhat shaken.

He ended up leaving with a few people to go to the ER and get checked out.

Thinking back on the whole thing, I wonder if I could have done anything else for him at the time. I certainly wasn't the one to spring into action after he collapsed. Well, I caught him and recognized that he wasn't doing so hot, but that was about it. He's a bit larger than me, so I thought at the time it was reasonable to let bigger guys in to try and lift him up.

In any case, that was the most exciting part of the night. There we were, a bunch of med students surrounding our classmate running through our differential diagnoses of syncope ("sin-coh-pee"), asking him questions about how much alcohol he drank (just 3 beers), a history of diabetes (no, only thing he could think about in his family was hypercholesterolemia), and his last meal (onion rings about 2 hours ago.)

Even though I was bummed out about this morning, it was a swift kick in the arse to remind me to study harder so I can stay in medical school. My quick reaction to Josh fainting made me realize why I want to be a doctor so badly. I'd like to know how to spring into action and really help someone in these unexpected times.

I'd like to be ready.

[edit] Josh sent an email to our class thanking everyone for their concern. He's going to be okay, he just had a combination of locking his knees, sleep deprivation and low-intake hypoglycemia.

Learning Life Skills

Today I learned how to intubate a patient.

It was a random thing that one of the MS-4s offered at the end of our anatomy class today. It was our first class challenge, really... something that some of us found very difficult and others, less so.

You hold this metal pipe with a little flashlight and a curved metal stick. Then you maneuver the whole device to down the throat of an unconscious patient, lift the tongue, visualize the epiglottis, lift that up out of the way as well and maintain your position while you get the tube ready. You can't brace yourself against the teeth because you can crack them or break them outright. A lot of people struggle at this point, arms quaking from the effort of lifting in the appropriate but awkward position. You sneak the tube in, inflate the cuff to seal the airway and remove the wire guide. A few pumps with a bag tells you if you stuck the tube into the airway if the chest moves up and down. If the stomach moves instead, then you hit the esophagus instead.

I actually intubated three times today with a 3:0 record! Granted, they were on mannequins in our simulated patient lab, but I still enjoyed it. It was really cool to successfully place a tracheal tube, so much so that I couldn't help but brag afterwards about how I learned a "life-saving skill" to one of my classmates who wasn't able to intubate. She took the dig in stride and I padded it a little by adding that she must have had trouble because of her tendonitis (which made her wrists sore on both sides at the same time!)

After a little mulling over, I don't know how I feel about this.
I am relieved that I actually have some clinical skill.
I look forward to the day when I can confidently perform this tricky maneuver.
I am happy that today, it isn't something that I necessarily needed to struggle with.

However, after watching "My Ocardial Infarction" from Scrubs, where J.D. experiences a humbling moment in which he falls behind Elliot in skill after bragging, I realized that I learned a bigger lesson today.

You can't let your ego get in the way of doing things well.
I feel that my classmates deserve more support than I deserve praise.

I heart House

There's only two TV shows that I'll drop all of my studying to sit back and enjoy. The first one is Lost on Wednesday nights. The second one is House on Tuesday nights. I've missed a lot of House, but I always keep myself up to speed on the best website ever!!!

Scott is a family doctor that runs Polite Dissent, home to House MD reviews. He posts a summary of the case with links to all the diseases mentioned and then he provides his own analysis of the results. "House" is rarely up to par with real medicine.

When I was watching tonight's episode, I was all happy because I thought I cracked the case halfway through. I commented on his blog. Here's a longer version of my analysis:

Hey, a first-year med student here. I thought I'd try my hand at a diagnosis tonight. When they mentioned strep infections, I thought about post-strep glomerulonephritis as the cause of the bleeding. It bothered me that it wasn't even mentioned. Do the writers even bother looking up the common differential diagnoses anymore? Rheumatic heart disease-induced clots come from atrial fibrillation (which would be easily seen on an EKG,) but I guess an RF vegetation could have embolized. :-\ The balloon catheterization struck me as bad medicine.

Before they came up with Mirror syndrome, I was rooting for Budd-Chiari syndrome.

My differential diagnosis went something like this:
Since this is a TV show, they'll pick something totally random and rare. It needs to have a cool name and involve as many different organs as possible. Hyperestrogenism is a hypercoagulable state. This could cause clots to form and cause strokes and a blockage of the hepatic vein. The hepatic vein blockage could be asymptomatic at first. Blood would back up in the portal venous system and jaundice would result. Weird splanchnic vasoconstriction would have fetal abnormalities and possible kidney involvement with the hepatorenal syndrome. Acute tubular necrosis could cause protein and blood to show up in the urine. It's all a stretch, but "House" always is.

My fun diagnosis was shattered when the transjugular procedure was clean. Drat! Besides, my diagnosis neglected to consider the ethical and curable issues... a "House" diagnosis needs to be controversial and it needs to have a miraculous recovery at the very last second.

I don't know how corticosteroids leads to pulmonary edema. I don't know how it speeds up the development of the fetal lungs also. If the fetus had a lower urinary tract blockage that restricted the development of the lungs, wouldn't there be oligohydramnios? Wouldn't that lead to POTTER sequence? Less amniotic fluid (which is just baby pee) would mean less room for the baby to grow, which could cause problems with limb development.

I didn't know enough about fetal development, so I just went along for the ride after that.

I liked all the drama in this episode. I thought that there were a bunch of very interesting role reversals... House/Cutty, Chase/Cameron, Cutty/Wilson. The way House stared at his hand at the end of the episode makes me think that there's potential for him to want a baby with Cutty! Haha! That would eat away at Cameron and in turn, break poor Chase's heart.