Mask of Medicine

It's curious that I've been talking about my adventures in med school a lot recently (most of my posts since August), and yet I've failed to explicitly discuss the Mask of Medicine that practically all med students, residents, and doctors wear. Unlike my other Masks, this Mask has some physical manifestations as a white coat, scrubs, and/or stethoscope.

This is a Mask that trumps all other Masks. When it's worn, next to nothing else matters. Time melts away, personal dramas are set aside, and you push through drowsiness and exhaustion - all that matters is that person in front of you. To say, "How can I help you?" or "What brings you in today?" and have a total stranger tell you some of his most intimate details of his life, to place his trust in you, how can you even dare think about anything else but that person in that very moment? All you care about, all you should care about, is helping that person the best you can. And when you do your best and you know that, you feel a distinct sense of achievement.

I'll be the first to admit I'm not the best med student in the class, book-wise. Heck, even with a 95% on one of my last exams I was still below average (or that my 82% on another exam is below the average of 89%)!! Nothing stings more than knowing that, though you've passed and actually did quite well, many many more students did better yet. But medicine is so much more than book smarts, so much more than memorizing pathways and facts. And so far I've taken consolation in that.

There are students who fail so badly at medical interviewing that you pray they decide to go into radiology or pathology, where they never have to see patients face-to-face (or at least, not much). There are students who desire to do the least amount of work possible and aim for the "lowest tier" of medicine. And there are many who scoff at evidence-based medicine (EBM) - who scoff at epidemiological study designs, biostatistics, and valuable critical thinking and analytical skills. I have a friend who feels he'll be too busy to read medical literature when he becomes a practicing doctor, saying he'll only read the abstract and the conclusions of the studies and base his judgments on that; I worry for his future patients.

And then I realize that at the heart of the Mask of Medicine is an extension and amplification of the Mask of Caring. My roommate accuses me of "thinking too much" about medicine, about the issues that we may face in the future in clinical care (then again, he's just a bum). That I think about how I can better improve how I interact with patients; about how the ability to read, interpret, and critically evaluate medical literature is more important than any amount of biochem learned throughout a single semester; about how important cultural awareness is when dealing with a population as diverse as the US; about how "unfriendly" most medical practices are to LGBT persons (mostly unintentional); and about how we can all personally improve how we conduct care - perhaps I do think too much . . . perhaps I do care too much. I'm not saying I'm the best med student to grace the clinics - far from it. If there's anything this Masks shows me, it's that I've a long long way to improve in all respects.

The Mask of Medicine is all-consuming, it often dominates the majority of my days. Medicine, as preached to me by every physician I've spoken to candidly, is more than a job. The doctors who treat medicine as "just a job" are not good doctors and are rarely happy being doctors. This Mask is an exhausting one, but often also a rewarding one.

---TANGENT---
Last night I watched a gay-themed movie called Eating Out 3. It's a rather silly film - a bit over-the-top, but also hilarious and had some pretty hot scenes. Interestingly, all 6 of the main male characters are gay, and read an interview with them here. One of the main characters, played by Chris Salvatore, is simply gorgeous:

He's also a singer/songwriter with his own myspace and YouTube pages. I listened to some of the songs at those 2 sites, and actually liked some of them. So head over and listen to some tunes. And watch the movie if you're feeling up for a laugh and maybe a couple "awww" moments.
---END TANGENT---

So Gross

Wednesdays are always rough - 8:15am until 9pm. Yuck. Anyway, the title says it all. Today was so high yield in terms of material to blog about! You thought the last post was bad, but today's anatomy lab was one of those we've been dreading. Proceed with caution, this stuff is NOT for the faint of heart. There's stuff at the end too, so if you want to skip the explicit dissecting details, don't feel like a wimp for jumping past it. BUT please read the first paragraph blurb so you know what the details are all about.

Abandon all hope ye who enter here . . .

---EXPLICIT DETAILS---
Today's anatomy lab involved the dissection of the perineum region. For my lab group this involved 2 things: removing the sigmoid colon and rectum (this part's unrelated to the perineum), and cutting off the scrotum and penis (because our cadaver's a guy).

1. On Monday the lab professors bisected everyone's cadavers axially (horizontally) such that the lower half of the body was disassembled from the upper half. The small intestines and colon were also cut. But they left part of our descending colon, our sigmoid colon, and rectum in. Unfortunately . . . it was full of poop.

So we have to remove as much of the colon and rectum as possible. I tied up the free end of the descending colon, but I must've missed some poop because as I was tightening the string, poop oozed out of the open end of the colon like gross brown toothpaste. I grabbed more string and tied it further down and we lopped off a good chunk of colon filled with poop.

Later a lab professor came by and told us that we still needed to remove more, as much as we possibly can. So I got more string, but we had to tie it now so close to the rectum/anus that it was hard to get the string down there. My labmate (future surgeon guy) deftly used 2 tweezers/foreceps and tied knots around the lower rectum, just like a surgeon would tie a knot or suture. We then had some difficulty cutting between the 2 strings we tied to ensure poop didn't leak out of either end. Unfortunately . . . we accidentally cut our last string. Thankfully his rectum and anus were mostly clean of fecal matter. I quickly threw away the second poop-stuffed colon "pouch."

2. The perineum region is the area (on a guy) below the penis and above the anus. Basically, the "taint." Future surgeon guy and I took a side and began cutting off his scrotal skin, all the while wincing. One of the girls had to leave early so we quickly "recruited" the only girl left in our group, Leslie, to "help" us. See, we had to cut around and under the penis, and it was just sticking in the way. So we had her lift the penis straight up as we cut away the scrotum under it.

The moment she held the penis up, several guys came by and commented on that, lol. It was quite amusing. I had remarked something like, "I wish we could induce an erection in death, because his penis is just in the way." That somehow became the quote of the semester in our lab group, lol.

So after we cut away the skin of his scrotum (of which he had lots - his balls were rather large), we cut deeper into the fascia until we could pull out the testicles. Again his testicles were pretty big. o_O We then tried to cut away and find the small thin muscles at the base of the penis. But the penis was in the way. So . . . future surgeon guy decided to bisect the penis at mid-shaft. I protested vigorously, but to no avail. So now we had a disembodied penis tucked somewhere elsewhere in the body. The look on both our faces must've been priceless, because this is just not something any guy would want to do.

Later we also bisected the penis ventral-dorsally (top to bottom), so now the stub of penis left connected to the body is bisected in half. We "had" to do that because sometime soon the lab professors are going to bisect the pelvises of practically every body down the midline.
---END EXPLICIT DETAILS---

P.S. If I ever discover that the above is against HIPAA or something, I'll of course have to delete it. I don't think it is because there aren't any identifiers, just the "procedures" we did on this cadaver.

Now I have two convos I'd like to share briefly. The first I found interesting, the second I found hilarious.

1. Background: our cadaver guy is uncircumcised. This is (mostly) the convo between the 2 girls (the 3rd girl was home sick . . .) in my group about it. Girl #2 is Jewish.

Girl #2: Why does his penis look bent like that?
Girl #1: I think it's because he's uncircumcised.
Me: Of course he's uncircumcised, that's obvious.
Girl #1: Well, I've never seen an uncircumcised penis before.
Girl #2: Really?! Wow, really? Never?!
Girl #1: Yeah. I mean, I've seen my fair share of penises, but none of them were uncircumcised.
Girl #2: I can't believe you've never seen an uncircumcised penis.
Girl #1: Well, my sample size is pretty limited to just [insert Midwest state here].
Girl #2: My first bf for 5 years is uncircumcised.
Me: Wasn't that the guy you would've married?
Girl #2: Yeah. I probably still would.

2. Background: I went to a patient care panel in oncology dinner thing tonight. One of the guys had pretty aggressive prostate cancer (he's in his late-40s to mid-50s). He's obviously alive and well, surgery and chemo went fine and all.

Him: "The surgeon gave me this little blue pill [Viagra]. And I told him it just wasn't working. He then referred me to this other doctor."

*goes to see this other doctor*

Doctor: "You need penile rehabilitation."
Him: ". . . What does that mean?"
Doctor: "You need to masturbate every day."
Him: "o_O Where were you during high school?!"

---TANGENT---
There are a couple blogs that have closed recently, and a few more that haven't updated in a while so I going to assume they're abandoned/closed, at least for now. I still follow all the blogs, but I follow anonymously if they're not currently active.

So farewell to:
Just me
MSTP Bound

And I hope to see the following blog again soon:
A Popular Dude's Secret Life
fictional

Lastly, I'd like to welcome a new blog on my blogroll by a blogger who's no stranger here. Head over to Welcome to Inglewood to see what that's all about.
---END TANGENT---

Up The Ass

It's not every day that you can say you had your hands shoved up someone's ass (muscles).

Yes, Block 4 has begun - perineum and lower extremities. First things first, the professors bisected all the bodies at around the level of the kidneys (bellybutton area-ish) so now everyone's cadavers are in 2 pieces. o_O Then we had to flip over the lower half and dissect the butt to get to the pelvis.

Proceed not for those with weak stomachs beyond this point . . . you've been warned.

After removing the skin from the butt, we had to clean off the fat and fascia over the gluteus maximus. That was gross. Fat is just so . . . yellow, and squishy, and greasy, and gross. Our guy has been generous to us - the lab table across from us has a woman bordering on obesity and she had inches of fat. Once we found the border of the gluteus maximus, we had to shove our fingers under there and find the ligaments, hence shoving my fingers up under his butt muscles. Those were some tough ass ligaments (pun intended)!!

And of course, the highlight of the lab. We had to insert a tampon into the anus, to "provide support" to the soft structures bordering the anus. We think it was just to plug up the hole so poop doesn't leak out while we dissect. The other guy in my group and I were quick to say "Not me" with regards to that.

So I gave Leslie the tampon which she so skillfully put in. Then she removed the applicator and had this look on her face, exclaiming "Was I supposed to take it out!!" The applicator had poop all over it. We all then kind of proceeded to "freak" at the grossness of this lab. Minutes later, we hear a lab group in the near distance freak at something. We concluded they also inserted a tampon into their cadaver's butt.

You know, it's good to know that despite cutting up the bodies and supposedly getting desensitized to it all, we're all still able to become utterly grossed out. Anatomy lab is also a great motivator to get one to at least consider losing weight.

---TANGENT---
I started watching this new TV show, V. It's about aliens, the Visitors, who come to Earth. It's a remake of a show way back when (that I've never even heard about until now). It looks like a good show, so I'm excited to see what happens next.

Also, it doesn't hurt that some of the main characters are hot. ;-)
---END TANGENT---

Push On Through

It's been a long week. But then again, I'm kind of used to this - in fact, it's a recurrent theme.

This week was Block 3 exams - thorax and abdomen. Anatomy and human development (devo) were both quite easy and I did really well in both of them. Then again, Block 3 was supposed to be the easiest block of exams and everyone's expected to do really well. However, biochem is as difficult as always. It seems that no matter how much or how hard I study, I just can't get the grade I want in that class. Grrr. I've determined that I suck at neuro and biochem. Block 4 is on the pelvis and lower extremities. Joy.
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Soon after my last exam (biochem), which was on Friday the 13th (how apt), I went to my mentor's office to shadow him. All M1s are assigned a mentor who we visit in their clinics. Mine's a pediatrician - he's a really nice old guy. I got to his office a bit before lunch and there was lunch provided for everyone in the clinic. It was a really nice clinic! His son actually joined his practice soon after finishing residency; I found that interesting (I don't think I'd ever be able to work for/with my dad).

After lunch he had some charts and patient notes to finish writing up, as well as phone calls to make. He gave me some things of his to read and look through - to "inspire" me about pediatrics I guess. Before we began he had talked to me about his philosophy of medicine, and I could see that played out in practice. He gave me some great advice which I'm sure will be of use to me later. He's a super-organized guy, which is of course a great quality for a doctor to possess. He's also close to retiring and doesn't really know how to use computers, and so laments the EMR (electronic medical records) system Obama advocates. I held my tongue, lol. Generation gap - typing is second nature to me whereas it isn't for him.

Starting at 1pm, we saw patients. In the span of just under 3 hours, we probably saw 10-12 patients (rough guestimate) - that's a lot, btw. He was almost sprinting (or as close as a 63-year-old gets to sprinting) from exam room to exam room. His poor nurse couldn't quite keep up with him, lol. There were a lot of well-child physical check-ups. I saw this really cute baby girl. She didn't like the tongue depressor and so bawled when the doctor tried to look in her mouth. The office visits were pretty typical and routine - "bread and butter pediatrics" as he called it.

He counseled a lot of parents to get the seasonal flu and the H1N1 flu vaccinations for their kids. It was quite interesting seeing the parents' different reactions to it - some were for it, some were against it, most were on the fence. At times it almost seemed like he was pushing a bit too hard to get kids vaccinated, though I understand his viewpoint - he's had several young patients hospitalized within the last 2 months due to H1N1. He doesn't agree with the way the government is handling the vaccination distribution (that is, they're doing all of it), and I'm inclined to agree.

Two of his patients were from "second generation" families, meaning that the pediatrician used to treat the parents way back in the day. I thought that was really cool - that you would love and trust your pediatrician so much that when you had kids of your own you'd take them to see the pediatrician you used to see. That in and of itself speaks volumes about him. He even has one or two "third generation" families, where he once treated the grandma/grandpa!

All in all it was a great experience. Though this first visit was pretty much exclusively shadowing, he said in the next 5 (mandatory) visits he'll show me how to use some of the typical equipment - otoscope, stethoscope, etc - so I can actually do something and do some things on my own. I look forward to that! I was exhausted when I got back to my apartment, and then I went with my roommate to join up with some friends to play poker. I lost, but I got damn close to winning this time!
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This morning (Saturday) I went to volunteer again at the free clinic for the uninsured. Unlike the first time I was there, I didn't have an M2 with me. So I saw patients and took their medical histories all by myself. I also took the first guy's blood pressure manually (because electronic blood pressure cuffs SUCK). I was somewhat off from the number the M3 got when she entered in with me later. Oh well, at least my measurement was still WAY more accurate than the machine's.

As an M1, I feel woefully ill-equipped to do much beyond just talking to the patients. The M3s kept asking me if I did a physical on the patients and I was like, "No, I haven't learned that yet - won't learn that until next year." I was pulling the "ignorance card" left and right, lol. I did get a little better at presenting the patients to the attending compared to last time (at least they didn't look annoyed at me), and I took more thorough histories than last time as well (I think).
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Okay, I'm exhausted now for reals. I think I'm just going to crash for the remainder of this weekend, lol. Thanksgiving does not come soon enough - I'm excited to go home. :-)

Final Countdown

A little while ago, SR-F emailed me the following YouTube vid:

Final Countdown - cellos and orchestra

The 3 cellists look ridiculous, but don't let them fool you - it takes a lot of skill to do what they're doing. The cello is an instrument meant to be played seated, so to play it standing and still be in tune and achieve the technical skills in the upper register is something I can't do. So while they look a bit ridiculous doing their headbanging and standing solos, it's quite a feat.

Now on to the "real" stuff while you let that vid play. Block 3 exams coming up this week. It shouldn't be as bad as last block. I've discovered that I suck at nerves and the nervous system compared to other organs. Identifying nerves gives me the most trouble unless they're super-obvious nerves. Blah. :-/
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Yesterday I spent 6-7 hours with 2 of my labmates studying lung and heart development. Omg, heart development is so complex; it took us several hours just to get through 23 pages of notes!! But I think we've got it down now, finally. I think we were starting to lose our sanity partway through as parts of heart development began to look . . . phallic. That was Leslie's doing, not mine, lol. I was able to approximate development drawings more accurately. :-P

In anatomy lab we've had this odd tendency this block to ascribe animal characteristics to body parts. For example, we call our cadaver's right lung "tiger lung" because it has black stripes across it. Presumably this is "normal" for anyone who lives in/near a city - so for all of us living said area, our lungs will apparently become striped.

The lab table across from us has an excellent heart dissection. But it looks like a snail, so we call it "snail heart." It's their coveted body part because it's such a good specimen (for the most part). We've actually opened their humidor when they weren't around, reached into their cadaver's body, took out the heart, and brought it back to our table for examining. Once Leslie tried to give them our tiger lung as collateral as well as "transplant" snail heart in our body. That didn't go over so well.

And just yesterday morning, we came across "T-rex heart" from the other cadaver in lab who died of congestive heart failure. They cut the heart across its entire length, so if you held the heart sideways and opened and closed it where it's cut, it looks like a T-rex opening/closing its mouth.

So this is what becomes of us in anatomy lab . . .
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Anyway, I've a theory about academic physician lecturers (pseudo-tangent, I know).

The pediatrics department provide our classes with great guest lecturers. They're so engaging, know how to communicate, are able to grab one's attention, and even instill enthusiasm about the subject. By contrast, surgeons and radiologists suck at explaining anything (but radiologists are the worst).

Yesterday I sat in a radiology lecture for anatomy. The radiologist just clicked through slide after slide after slide after slide without pausing long enough for anyone to really process what they were seeing. AND he was talking to the screen the whole time - didn't look at us or really even address us. I HATE that. I mean, if you're going to show me an ultrasound of the aorta and have it zoomed all the way in so that I don't even recognize it as an aorta, at least give me 10 more seconds to figure out for myself what's wrong on the slide. I seriously sat through the entire lecture and the only thought I had was how bad it was and how I could so do a better job.

This kind of reinforces my psuedo-stereotypes of the different specialties, or rather the kinds of people who go into them. As Leslie said, "You don't choose to go work in a dark room if you want to interact with people."

---TANGENT---
I (finally) got a haircut today. I hate getting haircuts. I hate my hair, I can never get it to do what I want or make it look good.

So I went to a place nearby to get my hair cut. The only Asian woman there "singled" me out to cut my hair, haha. She's Vietnamese and even I had some trouble understanding her thick accent, though her talking in a quiet voice didn't help any. At one point she randomly busted out Spanish because she had taken some Spanish courses. I just kind of sat there and was like, "Seriously?" She was skilled with cutting Asian hair (or so she says), because mine turned out decent. A tad shorter than I wanted it but that's okay, it'll grow out. She also gave me the name and address of a good Thai place. :-D

Lastly, it seems that I've gotten some new Followers lately! I don't know who you all are, but thanks for liking my blog enough to follow. ^_^
---END TANGENT---

Happy Birthday Landyn!

Hey Landyn,

Happy Birthday!! One year older but still plenty young, and plenty of time to work and play (but please emphasize the play on this day). I hope you're going to enjoy your day, relax with friends, go out and have a nice dinner (and have all of them treat you to it, lol).

And when you have time, visit this blog we made just for you!

We're here for ya, and you should know that by now. *Hugs* Best wishes with everything!! :-)

The Spirit Catches You and You Fall Down

In my medical anthropology course in undergrad, I read the book The Spirit Catches You and You Fall Down by Anne Fadiman. It's a story about an epileptic Hmong girl and the narration of her story from worldviews of her parents and of her doctors.

Imagine my excitement when I learned she was giving a guest lecture at my med school earlier tonight! Of course I had RSVP'd like a month ago in advance. How could I miss the opportunity to meet the author of a book that captured the beginning of a shift within the medical profession? How could I miss an opportunity to hear what pearls of wisdom I may gain from this lecture, especially as I'm involved in the Hmong Health Education Program (HHEP) committee here? How could I, as a med student, not sit in on a lecture so relevant to cultural competency to aid me in better caring for a diverse patient population in the future (especially since cultural issues largely aren't discussed at length throughout medical training)?

It was a great lecture. She was more down-to-earth than I had envisioned. She discussed the conflict that could occur between two cultures due to mis-communication. Indeed, there is a medical culture that contains within it almost everything you'd expect of a culture - it has its own hierarchy, it's own rules, it's own language, it's own special clothes, it's own rituals, and it's own worldview. One thing she said that will stick in my mind is the idea of a Venn diagram of patient-physician communication. There is always overlap, however small. Sometimes the patient, sometimes the doctor, often both, must venture to the periphery of their circles into the area where the two circles overlap - to where there is common ground between patient and doctor. This overlap is (apparently) called the "lune," and we must seek it as both patients and doctors to promote maximal outcome.

Afterwards, I had the luck (and patience) to have her sign my book! Okay, I actually left my original copy back home in another state. But an M4 (incidentally the M4 who started the HHEP) gave me a free copy of her book for the signing, so now I have 2 books and one of them has her autograph!! She drew that Venn diagram in my book, reminding me to find the lune. I also got to take a picture with her. This must be the first time I was so close to a celebrity, lol.

Her work is well-known in medical anthropology and in the medical community. To think that a journalist would have such a profound effect on the way physicians, bioethicists, anthropologists, would view cultural differences and how those differences impact healthcare (Mirrorboy, if you read this take note, maybe one day you'll produce some work that'll be the beginning of a paradigm shift). Unfortunately, formal training in medicine concerning cultural differences is severely lagging, even today.
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Now, for the other randomness in my life.

1. Apparently I'm no longer fit (I was never that in shape, but I was way more in shape 2-3 years ago). I judge my fitness by my cardio endurance, and right now I'm at under a mile on the treadmill. This won't do as I used to be able to run 2.5-3 mi. Then again I hate the treadmill as I usually can't run as long on treadmills as on ground (oddly enough). Anyway, exercising has now been bumped up into my top 5 priorities.

2. I participated in the disembowelment of the dead today. After 2 of my labmates left early, leaving just Jon and me in the lab, we decided to disembowel our cadaver so we could expose the posterior (back) abdominal cavity. We stumbled upon a whole new world! After we ripped, tore, and cleaned away the fascia (which one of my labmates describes as being "incredibly satisfying" - it is), we were able to expose the abdominal inferior vena cava (main vein going into the heart), the renal veins leading from the kidneys, and the kidneys themselves. There was definitely something satisfying and exciting as a result of this disembowelment (which, might not be a "true" disembowelment as we just moved all the intestines upward until they sat in the upper chest cavity).

3. It's creepily humorous in lab these days. In order to get at certain things to dissect, one must remove organs and place them all over the place. We had the left lung on our cadaver's face, his massive heart on his groin, his right lung next to his head, and his ribcage and calvaria (skullcap) near his ankles. Yeah . . . organs everywhere. The more one dissects, the less human the body becomes.

Okay, that's all for this episode of anatomy lab. My eyes can't seem to focus tonight, blah.