it's not art school

One of the curricular elements here involves students visiting a family with a chronic illness several times over the course of two years. We then form small groups and create an interpretive multi-media project expressing common themes in chronic illness (as well as writing a series of reflective essays). While the visits are enjoyable and certainly lead to reflection on what it must be like to live with a chronic health issue, this is medical school not art school. During the most difficult sequence of the M1 year I am expected to come up with an interpretive art project?!

My two partners and I have decided to create artwork using the board game Life. We are going to remake the game board and glue it and other related game pieces to a giant posterboard. It's supposed to represent that illness is not really in one's control and that it affects all facets of life on a longitudinal scale. Or something like that.

When we proposed the idea to our class there was a certain amount of horror: you are going to make a game out of chronic illness? Crap. We hadn't really thought that through.

The best projects are then chosen to be displayed at a reception that all the families (and medical students) attend. I'll put up $20 that our remake of Life is not chosen.

Rest in Peace

I would like to take a moment to honour the memory of a 3 year old boy I knew in Philadelphia. He recently passed away due to GI complications and a genetic illness. I met him several times over the two years I was there and his whole family were warm and wonderful people.

The End of Anatomy

We had our anatomy closing ceremony today. After seven months and 32 labs of dissection, we have completed the anatomy curriculum. The occasion was marked by a series of awards, given out by the legend himself, Dr. Burkel, for the best anatomy students. I received recognition for setting up the practice exams for every sequence (with my colleague Zach).

One of the body donors had written a letter to the students who would be dissecting him and it was read to the whole class. It was a poignant and appropriate moment, but it was nevertheless awkward. While I try to be respectful of the body I worked on (I never cut of random body parts for fun or put him in strange poses), I simply cannot think of him as a living, breathing man while I'm sawing off his cheekbone or cutting his genitals in half.

Anatomy was a rite of passage, but I'm not unhappy it's over. It's important and valuable material, but it's simply not my favorite subject. I will miss the anatomy faculty, they are truly great teachers and interesting people.

Histology is also over, but that seems less momentous. Onwards to histopath! Only two sequences left... infectious diseases and development (and some clinical weeks in between). Two more months, then I'm an M2!

Positive Framing

My dad likes to send me links to interesting articles he finds online. Recently I received one about Japan's health care problems (which I didn't read) in a journal that also had an article on characteristics of successful women (which I did read). Apparently these women exhibited something called "positive framing."

"Positive framing and positive thinking... are two different notions. The latter tries to replace adversity with positive beliefs. The former accepts the facts of adversity and counters them with action."

This, I think, sums up my last few weeks very well. They have been extremely turbulent and somehow, three days ago, my mind pulled the plug on the purely emotional reactions and kicked me into action-mode. It's not that everything is suddenly okay, but that I have accepted what is and decided on actions that will eventually result in a restoration of my usual level of happiness.

And I have to say, when I dried my eyes and took stock of the life I have, I was really grateful. I have wonderful, supportive friends who were there for me, the respect of my peers and professors and lots of interesting opportunities ahead of me.

I'm certain I didn't choose the easiest road, but I (still) think it's the best one for me. Besides, you can't "live to the point of tears (Albert Camus)" without actually crying once and a while.

Pediatric Cardiology #1: Healthy Heart

I recently began working in clinical research again; with the Congenital Heart outcomes group. The study I'm working on has a much wider ranger of diagnoses that my previous work so I'm brushing up on my pediatric cardiology (in all that spare time medical school leaves). I thought it might be an interesting topic to share here, so this post is a primer on normal functioning (I did the drawings).

Unfortunately, most of the diagrams you see in books are functionally correct (ex. above), but not anatomically helpful. If you open up someone's chest (from the front, ie anterior or ventral) you do not see two ventricles sitting side by side. Instead, you see something more like...

You can see immediately that rather than a right-left orientation, the heart is really more front-back (anterior-posterior). Also, the ventricles are not so much "on top" as they are to the right. Which brings me to another point, we name everything by the patient's orientation. Thus, the right ventricle is the patient's right side, not yours. The whole heart sits slightly to the left of midline in the chest and its apex (point) is roughly beneath the left nipple.
The way blood flows through the two interconnected circuits - systemic (body) and pulmonary (lungs) - is frequently disrupted in congenital heart disorders. Normally, blood returns from the body through the superior vena cava (SVC) and inferior vena cava (IVC) into the right atrium (RA). As the right ventricle relaxes (diastole) it fills with blood from the right atrium. This is accomplished through a pressure difference between the ventricle (low) and the atrium (high), which opens the tricuspid valve. When the ventricle is full, the pressure will be higher than the atrium, pushing the valve closed (creating unidirectional flow). The ventricle contracts (systole) and blood enters the pulmonary trunk (through the pulmonary valve). The pulmonary trunk divides into a right and left branch to the right and left lungs. Each of these eventually becomes a capillary bed, which drains into small veins, which drain in to the 4 pulmonary veins. The pulmonary veins drain into the left atrium. As the left ventricle relaxes it fills with blood from the left atrium (same process as right ventricle, except the valve is called the mitral valve). When the left ventricle contracts it sends blood into the aorta (through the aortic valve). From the aorta blood goes all over the body and returns to the heart via the SVC/IVC.

There are two structures unique to babies' hearts: the foramen ovale and the ductus arteriosus. The foramen is a hole in the wall (septum) between the two atria. It's open and birth and normally closes in the first few days of life. Failure to close is called a patent foramen ovale (PFO) and can ultimately lead to congestive heart failure. The ductus is a vessel connecting the pulmonary trunk to the aorta. In fetal life it's used to bypass the lungs and it too usually closes soon after birth. Both of these conduits allow for mixing of blue (deoxygenated) blood and red (oxygenated) blood (which is a normal person is bad).

Summary: SVC/IVC -> R atrium -> (tricuspid) R ventricle -> (pulmonary valve) Pulmonary system -> L atrium (mitral) -> L ventricle -> (aortic valve) Aorta -> systemic circulation -> SVC/IVC

Key Points:
1. Ventricular filling is accomplished (almost entirely) through pressure differentials
2. The valves closing properly is important for unidirectional flow
3. There are two conduits for shunting blood from the right heart to the left: the foramen ovale and the ductus arteriosis
4. The pressures in the right heart are normally much lower than those in the left

If there are any questions, let me know and I will attempt to clarify. I only gets more complex from here!

Silk Road Project concert

I went to a classical concert last Saturday of the Silk Road Project. It was absolutely phenomenal. It's a company founded by YoYo Ma (yes, he and his cello were there) that incorporates instruments and musicals styles from all over the world and across many periods in time. It's a sort of classical-jazz-world-improvisation type of fusion that's unlike anything else I've heard. They've recorded a few albums that are on itunes (audio on their website too); I recommend giving it a glance and if they come to your city, go and watch it live.

I also got to hear YoYo Ma say the phrase "Go Blue!"

Frustration

Medicine is an interesting career in that it has very specific points at which you are forced to make a choice about what you want. The quintessential one is match day; there is a specific date on which everyone finds out what residency (and where) they will complete. For the current M4s, match day is this week. Medicine is also unique in that you are told where you will go - you don't get to weigh offers and choose one. You interview, you state your preference, and you hope to god you get what you want.

I have a lot of friends outside medicine right now trying to change jobs or get into graduate school and many of them have mentioned they envy the structure medicine provides. The next few years of my life are basically planned for me, but I find that terrifying. What if I can't make myself attractive to a residency program I want? What if I get stuck in a city I hate? What if I choose the wrong residency type (ie peds vs. surgery)?

I feel as if I have given up so much to do this, to be a doctor, and it doesn't end. I gave up a financially better career (banking) in a phenomenal city (NYC) to spend two years in night school just to apply to medical school. Now I'm living in a place I don't really like that's far from family and friends because it will give me the best chance at one of my top residency choices. I don't have the time (or energy) to play tennis or read books anymore and I can't keep a relationship together. I can't even make it to a friend's wedding or my 5-year college reunion. What do I have to give up next?

I know that what I'm doing is the best investment for my future and that I truly want to be a physician and yes, I am aware that eventually, when this is all done, I will have job security and a decent income (well... that depends a little on Obama...). I guess I just wish I was a little happier now. It's all well and good to plan for your future, but I seem to forget that I have to live in the present.

.... and I'm back

I know it's been a while since I've posted regularly. I can give you all kinds of excuses (medical school is a lot of work, I've been traveling a lot), but honestly it doesn't mean much unless you see me post regularly again... so let's see if I can manage that.

The first year of medical school (to date) has been a little different than expected - there is a lot less patient interaction than I was accustomed to while being in the hospital. It's a lot more social than you think - we work really hard but we go out a lot too. On the other hand, it's also cost me more than I expected and I don't likemy geography at all. I love my school and my classmates, but I don't like living in Michigan (too far from friends/family/big cities). Some notes:

1. I hate anatomy. It takes up a lot of time and it's not that interesting. Apparently this means I am unlikely to become a surgeon.

2. I love video-taped lectures and flex-time quizzes. It gives me autonomy and allows me to pursue activities outside of class.

3. I was in a swing dance performance



4. I am doing clinical research again (on HLHS). I didn't realise how much I would miss it, so it's really nice to be able to work that into my schedule.

5. I am a MedBuddy coordinator - we pair medical and nursing students with children in the hospital for extended stays. The students visit the kids 3-4 times a week. I also have a MedBuddy - cutest little girl ever!

6. Two of the papers I was co-author on have been published!

7. During an a series of alternative medicine lectures I received a massage and had an acupuncture needle put in my hand (it feels weird).











8. I went to the inauguration










9. I went to Rome, Florence and Paris for spring break










Ok - I think that covers some of the cooler tidbits. I will keep you updated!