Stroke and accidents

This week we've been focusing on life after a traumatic accident or after a stroke. One of the patients I saw (who I interviewed for almost 2 hours) had just had a stroke. She's thin, looks healthy, and walks (make that walked) around. But she is 85 and just lost her husband of 60 years (!!). Did that give her a stroke? Why did her body decide this particular moment to fail a little bit in its blood supplying job to the brain, rendering her leg and arm a dead weight?

"My" patient was upbeat and hopeful, given that she has a little mobility of some fingers. But after talking to the doctor I realized that this upbeatness is out of blissful ignorance, as she probably won't be able to walk again without a walker or go up her stairs--among other things.

I realize that 85 is a great age to make it in good health. She's lived a long life and she told me that she was "ready." It's the natural course of life, and it is a matter of time, and not of whether, that "mishaps" are going to cause our bodies to fail us like that. But I still have trouble accepting it. I guess it goes back to death and our coming and going in the world...maybe I haven't thought of that as much as I should. I am sure I will have plenty of opportunities to face death and the natural path of life in the next few years...

On the other side of things, the unnatural courses, we had a presentation by the Medical Center CEO, Dr. Berk. He had a biking accident in June that fucked up his C3 vertebra. And there went his ability to walk, grab things, control his bodily fluids, sign his name, wiggle his toes. Dr. Berk was not a CEO for no reason, and his talk was eloquent, matter-of-fact, and devoid of any self-pity. He simply took the turn too fast and skidded and went over his handlebars to break his neck upon landing. And as he was laying there, beginning to pant, he realized exactly what had happened, how high his break had to be for his diaphragm to be out. And he felt the sensation in his limbs leaving him, some of it without return, as he was laying there. Scary, huh?

He is back to work now and has a superduper chair that enables him to be a little taller than me if he presses a button, which I guess is good if you go to a lot of fundraisers where people tend to spill their drinks.

And sure, he still has an amazing job and a wonderful family and many things to go for him.

But he broke his neck. Not at age 85, but while still youngish. And even though he is gaining some sensation and some movement, he is now faced with a life very different from the one he had envisioned.

With this also I have issues (who doesn't!). And with the cases we were presented with right after the conference, like a teacher who had a skiing accident while in his 20's. Yep. Wheelchair for the rest of his life. Now happily married, happily employed as a 5th grade teacher. Looks happy and hipermegaenergetic. So why does it depress me?

I went on a ride today because it was over 30 degrees (most of the snow on the roads is gone) and because I am physically addicted to my bike. But as I was coming down new, unknown turns, I was sure slowing down more than usual.

The soberness of our week doesn't end up here. We've also been learning about all these genetic disorders that can be really messed up (and are more frequent than I ever thought). Just like last week we had patients with disabilities that were obviously living a full, satisfying life, we had a parent presentation this week of parents of children with disabilities that seem more overwhelmed than happy with their kids. And that might just be my impression.

Ahh. The weight of knowledge. Time for some Twilight (what!).

~e

Ice and First Patient

So the ice skating was fun. My first lap consisted of very tiny steps, and many of my classmates stopped to make sure I was allright, held my hand, and gave advice. There was no rail or wall, and most of these people have grown up skating. I was of course the Southern Spaniard from Oregon who hadn't been on a rink before. But at the end of the night, I was "skilled" enough to compete in dives, which is when you go as fast as you can and then dive on the ice, and whoever goes further with their body wins. I had a blast, obviously.

But to more serious things. Today I saw my first real patient, at a hospital. We were briefly briefed in what to do and there we went. My partner and I were given 90 minutes to obtain a history and perform an exam. I thought at first that 90 minutes was gonna be a looooooong time, given that the doctor I shadowed spent an average of...I don't know, 30 minutes, with each hospital patient.
But time went by superfast. She had many things to tell, she was very interesting, and she had many many medical problems. I only felt frustrated when she sought reassurance from us and we couldn't provide it. First, we don't know anything. And second, even if we did, the news might or might not be good. That's gonna be hard, ain't it?
But anyways. It was an awesome experience. In the midst of all the textbook stuff, it is so wonderful to be able to actually get a feel for medicine.

I'm gonna stay out of her story for many reasons, but I can tell you this: when I introduced myself, she said, "Oh, Esther, biblical!!," not knowing that everyone in Spain had to name their kids with names out of the Bible or fear being boiled in oil by their in-laws/parents/neighbors... So she later asked me what church do I go to. I was able to hide my chuckle. I wanna say it's been a couple of years since the last wedding (and thus the last time I went to church). Then she lectured me a little, that we have to care for our spiritual self. I got out by saying that I didn't need to care for my spiritual self at church, that I could do it elsewhere (I did not tell her that I did it in my once-a-week 15 minute yoga routine...).
But yeah. Good thing that I am going to go by Dr. CM. Otherwise this might get tricky...

Time for some Genetics...
~e

Oh. And IM training started this week. Which meant running in 16 degree weather that felt like 6.
Only my toes felt cold. And it was a bit tricky to run in slippery snow.
But now i think i might have a frigging cold. Maybe I caught it on the airplane, no? Can't possibly be from running!!!!

Week 1.

I know it's still thursday. But darn, Med School moves so fast!
So from break we dived right into 8 hours of lecture on Monday. And on it goes. The good thing is that most lectures are done by an amazing teacher/pediatrician. The bad thing...EIGHT hours of lecture (which translates in 8^200 hours of studying).
We're learning Genetics (labs are done, YAY!!), genetic disorders, chromosomal abnormalities. And the very cool thing is that every 3 lectures or so, we get a patient presentation. Say, for instance, that we learn about cerebral palsy. That day a woman with the disease comes in and tells us what it is like live with a disability that makes her speech and gait appear like she is drunk, and that makes her motor coordination so poor that writing anything is a real hardship for her. This woman was as alert as you and I (well, at least the day that she presented, more alert than I am), and at least as intellectually capable as anybody in my classroom. Yet, she was sent to a "special school" when little, was told that couldn't get a degree, and had a hard time finding love and praise in her life. Just because she sounds drunk. But stubbornness and a bit of luck allowed her to find a fulfilling career path (as a social worker) and she has been blessed with what it seems like a wonderful family (who seems a lot less bothered by her disability than she is). And she is able to come to med school to teach us all about focusing on what she, and all people with disabilities CAN DO, rather than on what they can't. Focus on my abilities, she said, not on my DISabilities.

We're also preparing for next week (when we start working with real patients) by having pediatrics clinical examination presentations. That is, they bring a few kids and their parents, and they show us some tricks to examine a terrorist (that is, a 15-18-month old) without causing an uproar. Or they tell us that part of caring for a kid is to schedule an anti-terrorism policy appointment with the parents (ie, have a talk about the terrorist's behavior, what's normal, what to expect, etc). This is far from a classical classroom setting, as our teacher is doing this in front of 100 of us, while the kids are being supercute and crazy, and the parents are telling us how they cope (and what do they think of their pediatrician...). Even though I am not really into pediatrics, I have to say that it was an awesome conference. All of us had a smile on our face for at least 80% of the presentation. Kids sure can be cute!

And here is the other thing. We were studying chromosomal abnormalities that might lead to, say, a person with male genitalia but that has boobs. Conveniently, i have just finished Middlesex (the story of an intersex person). And I have a good friend that has posed many many questions about sex versus gender. So I go and ask the teacher what does he think that determines sex identity. He says sex chromosomes. Your other genes. Your anatomy. But then he says that really what matter is our attitude. That we need to keep an open mind. That it doesn't matter whether Calliope is raised as a girl or as a boy, as long as her parents love her, as long as if there is a point in which she decides to switch genders, it comes in a loving environment where she feels supported. Open mindness, he keeps saying.

So for this week I have been taught to keep an open mind about "dis"abilities. And about gender.

Man. I love med school!

Oh. And I am going skating tomorrow. Will let u know if I loose my teeth :)

Gotta get to bed. Week 1 still has 4 more lecture hours!!!
~e

DUN!

First semester of med school is over. That´s an eigth of it, and I´d like to say of tests too but you have to count the countless tests I will have to take once I am a physician (they never end, apparently).
Classes turned hard, I had to focus on memorizing a zillion facts, shapes, clinical correlates, nerve endings, nerve beginnings, arteries, veins, lymph nodes, muscles, brain compartments, brain injuries, highlights of brain development. And then liver (origin/anatomy/arteries/function/compartments/clinical correlates/how to drink wisely...). And then kidneys. And lungs, and heart, and gut, and that whole pelvic area, including a day in which the spotlight in lecture was turned to the G-spot and its erectile muscle (we have awesome teachers!).

Anatomy had the funniest days but it was the hardest to endure. When we took the eyeball out and cut it in half, I thought that the worst was over and it was going to all be downhill from there. But then, there was this day when we cut the pelvis in half. With a saw. And then the day that we had to cut the rectum in half. And no, it was not magically empty (nor were the seminal vesicles!!). I think it´s great we get to dissect a body, now I even know what side of the body the liver is at (what!). But that smell, that smell I am not going to miss at all. Yay for being done with Anatomy forever.

I did not get to say goodbye to my cadaver though. I saw her last in the Anatomy final, where her pudendal nerve had been tagged with a yellow pin. I´ll get to say goodbye to her spirit, if it will travel from the nasty-smelling room of the fifth floor to the chapel, where we will hold a memorial for all 26 cadavers. Those talented classmates of mine that sing will sing, those that play an instrument will play, and I will probably just bake a shitton of cookies.

We haven´t just been cutting body parts though. We also spent some time at the Histo lab (Histology is a newly discovered phobia for me), where we have supposedly learned to differentiate the esophagus from the vagina (some of us might have had extra trouble with the distinction...). We´ve also learned the basics of doing a physical. I can now listen to your heart in the places where murmurs should be heard, I can listen to your lungs in places where fluid should be detected, and I know where to check for a pulse in your foot. Can I actually detect a murmur? Can I actually find those distant pulses? Can I tell that there is fluid in your lung? Probably not. I am just a toddler with medicine now...I don´t think I even know enough to be dangerous. But it is exhilarating to me that I am learning about all this. So, like a toddler, I am very very excited about my new set of toys. I just wish I could stay excited forever...

I´ve also started working in a migrant health clinic. We went out in the fields and gave flu shots, checked blood pressure, and offered HIV tests. The migrant workers are Mexicans who come to pick apples near Rochester, who live in humble mobile homes for weeks at a time, and who obviously have no health insurance. This year, raids were being conducted to send them back home. Because, you know, all of us Americans really want to pick apples in those conditions. But I digress...this is the field I think I want to get into when "I grow up," so it was really pretty cool to be able to help somewhat while I am still a toddler.

Sooo overall a pretty hard beginning. Lots of work. But I do love medicine, I love how useful all I learn is, I love learning about the beautiful human body and all the things that go wrong with it. And no, I don´t just study and cut body parts all day. I also have made a bunch of friends, have given a fair chance to East Coast beers (but nothing has come close to Ninkasi!), have run for a bit, have traveled for a bit. And I´ve even gone to a reggae concert by a Hasidic jew from Brooklin, down from my house (and got a little high by second-hand dope).

I miss the best state there is, and my friends, and my students (who were on average older than my average classmate!). But I am telling myself that it is all worth it, because honestly, learning about the G-spot´s erectile muscle is a lot more interesting than that Schröedinger equation and all of its variations. And it makes better dinner conversation :)

So long. More later. Have to help cook now...
E

Corazon, corazon

Hoy le hemos sacado el corazón a Mary. Tiene (tenía?) un corazón pequeñito, con una aorta bien grande y un poco calcificada. Uno piensa en películas de vampiros, o en El Silencio de los Corderos, o en chorradas por el estilo. Pero la verdad es q es una pasada tener un corazón humano en las manos. Y si una se pone a pensar en que sólo en Estados Unidos hay 80 millones de personas con enfermedades cardiovasculares, de las cuales casi un millón muere al año, no se puede pasar por alto el hecho de que este órgano, tan pequeñito en Mary, es tanto una maravilla de la evolución como el talón de aquiles de nuestra civilización. En Mary, la calcificación de la aorta (q es simplemente q está un poco dura) ya daba a entender q la mujer tenía problemas de corazón. Y fue lo que la mató, según el certificado de defunción y lo morado de los músculos alrededor del tórax (pues le dieron primeros auxilios).
Tras identificar los nervios, arterias y venas importantes alrededor del corazón, me he metido en la biblio y cdo he mirado el reloj me he dado cuenta de que llevo casi 5 horas aquí. Se me ha pasado el tiempo volando estudiandome el recorrido de la sangre del cuerpo al corazon, del corazon a los pulmones, de los pulmones de vuelta al corazón, de donde, a pesar de ser tan pequeño, es capaz de bombear sangre hasta el dedito pequeñito del pie...Una pasada. En un minuto, el mio hace el recorrido unas 50 veces. En un colibrí, pueden ser mas de mil.
Joe. Es q es chulisimo!

Ah. Y ayer aprendí a oscultar. Q yo me creía q la respiración se iba a oir superfuerte. Pero no, hay q pegar la oreja bastante! En fin. Aviso q ahora voy a todas partes con el estetoscopio, x eso de practicar un poco. Asi q cuidadin, q a lo mejor te ausculto!

Today we took Mary's heart out. She has (had?) a tiny heart, with a large aorta with signs of calcification. I thought of vampire movies, or The Silence of The Lambs, or stuff like that. But in reality, it's really cool to hold a human heart in one's hands. And if one considers that just in the States there are 80 million people with cardiovascular disease, from which almost a million dies a year, it's hard not to think that this organ, so tiny in Mary, is both a wonder of evolution and the Achilles Tendon of our civilization. In Mary, the calcification in the aorta (that simply felt hard) already suggested that she had some cardiovascular issues. And indeed it's what killed her, according to her death certificate and the bruising around her thorax (thanks to CPR). After identifying the important nerves, arteries, and veins around the heart, I submerged myself in the library and when I looked at the clock, I realized that I've been here almost 5 hours. Time just flew while I was studying the path that blood takes from our limbs to the heart, from heart to lungs, back to heart, from where, despite it being so little, it can pump blood all the way to our little toes...It's just awesome. In a minute, mine does its lap 50 times. In a hummingbird, it can do it over 1000 times... Oh. And yesterday I learned how to auscultate the chest. I thought it would be loud and clear (as I heard it on my textbook's website). But no. It's nice and faint. Oh well.

Back to the heart :)

First big test/ El primer examen

Aghhh. I have not studied like this since undergrad in Spain. Sooo much to memorize. Sooo little time. I like it all. I wanna learn it all. It is all interesting. I like the teachers. Oh. Wait. Did I say I like it all? I still don't like the formaldehyde. And I did about pass out when we pulled the towell off the face of our cadaver. And I don't love histology. But I still think it's interesting. Then again, so much stuff, so little time. Our first big test is next Monday, and there is, oh God, SO MUCH I haven't gotten into my little brain. The cool thing is that I can already tell if an EKG is abnormal, and maybe even tell you what kind of arrythmia it's showing. Ain't that awesome?

The uncool thing is that I know NOTHING about all those microscope slides. And I think there are 100 of them. Soooo...uhmmm...more on this later :)

Ahhhhhh. No he estudiado tanto desde Quimica. Taaanto q aprenderse. Tan poquito tiempo. Me gusta todo. Lo quiero aprender todo. Todo es interesante. Los profes molan. Oh. Un momento. He dicho q me gusta todo? Todo, todo, no. Todavia no soporto el formaldehido. Y casi me da un jama cuando le quitamos la toallita de la cara al cadaver. Y la histologia no me mola. Pero aun asi es interesante. Asi y todo, tanto q aprenderse, tan poco tiempo! El primer examen es el lunes, y hay TANTO q no me he metido en la cabecita!

Lo chulo es q ya puedo leer un electrocardiograma y decirte si indica problemas, y hasta decirte el tipo de arritmia. Lo no tan chulo es q no se NADA de todas las muestras de microscopio. Y creo q hay unas 100. Asi q esto...hasta luego!