Mile 3166: Firsts

Above: May 2009. First time I ever popped an umbrella with Mary Poppins. I hope there'll be a second time.

THERE'S ALWAYS A FIRST
FOR EVERYTHING.

Last week was filled with a bunch of firsts. Here's five.

1. FIRST BLOOD DRAW.
Blood drawing can be intimidating for all the parties involved. On the patient end, seeing needles and blood is not exactly a pleasant sight. On the doctor end, it can be scary to not find a vein or take a wrong approach to inserting the needle, as both may cause discomfort to the patient. Adding both can lead to a stressful situation, but with the help of the patients in the chair, it made my experience much more inviting.

"If I can be the guinea pig and can handle being drawn blood from all of these sites, you can do it," one of the patients told me. I came out clean and was honest about telling the patient this was my first time. Tourniquet on. Search for vein. Spotted. Alcohol swab. Swished it around. Insert needle. Tube in. A flash of crimson blood entered the tube and it began to fill. I thank the patient in the chair for making my first try successful. I guess the first time isn't so bad with the right support.

2. FIRST FETAL OCCULT BLOOD TEST.
Okay, I'll skip the details, but we had to analyze for blood in a patient's stool to eliminate the possibility of any GI conditions. When our attending requested someone to do it, the hand that always gets me in trouble went up in the air. I soon was in to get the sample. This first showed to me that after the first time, its easy to get into the rhythm of things. Sometimes, exposure to the extreme is just what one needs to cross barriers.

3. FIRST PAP SMEAR ASSISTING.
I wanted to say "actual pap smear," but this was simply an assist. Getting a pap smear is intimidating for a male-doctor-in-training, for obvious reasons. But with the help of four other female doctors & nurses in the room, I was able to get through it. A complex process if done by self, but hopefully I'll be able to be in the hot seat with my awesome support team finally this week to try one.

4. FIRST TIME IN COUNSELING MODE.
I won't get too much into the story here, partially because of HIPAA and second because most of the situation occurred in Spanish (a lot more than Señor Fixity-Fix-It below). But I learned today that there are times that it is okay to step across the professional barrier, and not call someone by last name and to be honest about what's going on.

A lot did go over my head during the patient interaction, with some translated by an accompanying PA in the room. However, with even the little I knew, I went ahead, was honest, and told the patient, "No hablo mucho español, pero cree que eres un hombre/mujer fuerte. Puedes hacer todo,"* the reply of "Gracias" and a smile made me know that I connected with the patient when I needed to. I'm a sucker for emotional moments, but they're one of the most beautiful things about life.

*Translation: "I can't speak much Spanish, but I think that you are a strong man/woman. You can do everything."

5. FIRST BERRY & OREO ICE CREAM COMBO AT COLDSTONE CREAMERY.
One word: simply amazing. Okay, that's two, but that's how good it was... especially after enjoying the new movie release Kick-Ass.

And with all these firsts, I hope there will be seconds.

Mile 3106: Pimped

Above: With a careful eye, this overexposed picture outside my apartment shows a traditional occurrence in Florida weather, the sunny rainstorm.

I'LL TAKE THE
PHYSICAL CHALLENGE.
The best way to play the 1980s Nickelodeon game show, Double Dare.

MONDAY, 9:03 AM. Six medical students, and one physician assistant in training are all wearing white coats and sitting on huge beige pillowy leather sofas right outside of the doctors office. Some are waiting patiently, with their legs crossed and eyes toward the wall, while others seemingly less patient, get into the rhythm of tapping, some with their pens and others with their feet. Being this the first day, we do engage in some small talk as we wait patiently to begin our day.

A creak at the door awakens all the students out of their trances.

A doctor comes into the room, sits down on a sleekly designed roller chair and rolls around to each of us to welcome us to the clinic. After he finishes his round, he gasps, and rolls over to one of the students sitting two seats to my left, leans over and asks him:

What do YOU think you're strongest on?

OH SNAP. Usually the following concept is great: Say something you're strong at when someone asks you for your weakness. However, the opposite would be bad... Especially here, since the doctor then started popping questions out of his head one by one by one. He soon came up to me and asked me the question. It was my turn to engage in "the game." The word that involuntarily came out of my mouth was "Endocrinology." And soon I felt I was playing one of those shooting games as he was firing the questions out at me like a mad man.

Hit. Miss. Hit. Hit. Miss.

The final question he asked me had to be what he thought was the toughest one, because as he leaned over in his rolling chair to ask me it, his right eyebrow upturned, and he started to massage his chin with his right hand. He stared at me like he was focused on his target and soon started to ask me about what nuclei produce the hormones released in the posterior pituitary.

It took quite an amount of effort for me to say the words "Supraoptic" and "Paraventricular," partially because this is Step 1 information that I have not looked at since my exam. I thought I'd follow the general piece of advice to go with my "gut." The words came out of my mouth one sy-lla-ble at a ti-me.

A half-smile grew soon on my face rather nervously after I said those words. A moment of silence began.

"You are an expert," he suddenly said, as he extended his hand, smiled with a gentle chuckle, and shook my hand. My simple reply was a rather nervous, "I guess I am." (To this day, I still think, "I guess I got the question right.") After seeing some patients that day, I walked out the door feeling like I had been just slapped with the stamp on my forehead that said:

"PIMPED."

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I believe in challenges. Provided that the one giving them does them for the right reason, not being able to meet all of them shouldn't be discouraging: Mistakes give me motivation to become better. And this is the first time I've undergone the medical school teaching concept called pimping. From my understanding, pimping is getting asked a series of challenging questions on the spot revolving around a concept when in groups during clinical rotations.

I like it, it forces me to think on my toes, and because someone actually wants me to be responsible for the information, I get myself to learn it. Getting feedback and evaluation on what you know and don't know is very useful in medical education. This philosophy continues on in residency and when I become a real doctor, because it isn't the teacher who will drive me to learn; my patients are going to expect me to be responsible to have the right information so I can treat them correctly.

For more on the effectiveness of medical school pimping, check out this New York Times article from 2006.

(And just to make sure it's on the record, this week was filled with firsts, including my first Digital Rectal Examination and my first blood draw on real patients. More on this later.)

Mile 768: The Learning-Teaching Pairing

Above: The Chicago skyline on the NB U.S. 41 Lake Shore Drive to SB Interstate 55 flyover. I love flyovers!

"SEE ONE, DO ONE,
TEACH ONE."

2007. I recall one of our professors in the anatomy lab at the campus in Dominica was talking to us about how things "roll" in the anatomy lab. After our class was split into three groups, one of the groups each day would go on in to the lab and dissect a part of the body. For the people who weren't dissecting on a given day, they had to come in and watch the group that was currently dissecting give a demo on what they found out on that day. And for the next day, we'd rotate a group, and the process was repeated over and over again throughout the semester.

Dr. Martin said this was his philosophy, to see one, do one, and teach one.

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There's truth to that statement, and I'm seeing how it works firsthand in the wards. For instance, this past week, our attending doctor had demonstrated to us how to perform a neonatal physical (see). As a group, we then spent time everyday to perform the physical exam (do). Finally, when a new group came in to work in the ward with us, we spent the time to teach them the procedure if the doctor wasn't available (teach).

And through doing all three, I would have gone through either a procedure or a nugget of information, three times (and the procedure amazingly stuck!). Most would agree that in order to teach one has to learn. However, for me (but not for everybody), to learn one has to teach. It is commonly said that becoming a physician is a career of lifelong learning.

Right now, at this stage as a medical student, this is how I see it:

Throughout our careers, we have to keep up with the continuous research that goes on, filter out what's appropriate, and pass that information to improve the care of our patients. When we teach them what we learned (one way is through a doctor visit), I think that we have to pay attention to our patients, such as if we are communicating our ideas effectively to the patient or how well the treatments we plan are working. If something's wrong with that, we have to go back to the drawing board and start learning about that issue from square one again.

So after all that, I'll have to say that teaching and learning go hand in hand, and for me, one can't go without the other. For me, being enthusiastic about medicine (or just about anything) can make the processes of learning and teaching exponentially addictive.