So there’s a white coat hanging in my closet . . . now what could I do with that?

Let the clinical exposure begin!  (ok, shadowing doesn’t necessitate a white coat, but it’s a good segue)

My first step into the patient room (from the other side that is) took place at UTSW’s Monday Clinic.  Each Monday, teams of MS1s, MS2s and an MS3 or 4 team up to interview, examine and diagnose patients at a North Dallas Shared Ministries clinic.  Finally, my chance to see a REAL patient!  They say you never forget your first patient, and while this wasn’t actually my personal patient, Mr. Valdez will always be at the back of my mind (especially now that he’s codified here).  The MS2 led the history and we conducted physical exam under the guidance of our fourth year; looking into Mr. Valdez’s eyes, ears, mouth and nose and listening to the beat of his heart and lungs, we identified crackles from the air’s fight to escape his infiltrated lungs.  What we first presumed as acute rhinitis quickly transformed into a potential case of bronchitis or pneumonia.  After the attending eliminated our constructed differential diagnoses, we prescribed Mr. Valdez some (free) medicine and sent him on his way.  For our second patient, it was my turn to interview.  Uh oh.

Thanks to the kind guidance of our MS4, the history of Mrs. Sandez’s urinary tract infection flowed along smoothly.  During the H & P, we addressed the tell-tale signs of UTIs and ruled out kindey disease to sufficiently diagnose the malady.  Our only bump, a negative UA (urinary analysis), was easily explained after a bit of investigation.  It turned out that when Mrs. Sandez encountered symptoms of her UTI, she obtained some medicine just as she did last time (which happened to come from a Mexican drug supply source here in Dallas!).  Nonetheless, this time the medicine didn’t work as well and she stopped the dosage prematurely.  After the story pieced together, we prescribed some ciprofloxacin and Mrs. Sandez was on her return to good health.

At the Monday clinic, I had a seemingly obvious revelation.  The history, not some simple diagnostic tool, is instead a diagnostic pathway or map.  With the tools to correctly navigate the convoluted path of human pathogenesis and its manifestations, a cure is possible and with the correct training, it becomes probable.  By 2012, it will be UTSW’s job to divulge such abilities, the pathogen’s job to present such opportunities and my job to take advantage of it all.  (Is it me or are most of these endings turning out to be more like little personal pep talks?)

Until next time . . . the ER!

Since this week has been the epitome of studying deferment, why not put genetics off just a little longer?

After our big test on Monday, it was understandably hard to get back into the groove of it all. To make matters worse, a October 23rd ticket to Ben Folds added to my distraction. After getting a little genetics in here and there, Thursday finally arrived and I ditched my usual afternoon in the anatomy lab to stake out my spot in the front of the line. Five hours later, a few other UTSW students and I were front row, chanting for Ben to take the stage. When the lights finally dimmed, a monk-esque track of BF brewed more excitment until Sam, Mr. Reynolds and Ben arrived, starting with their aptly named “Way to Normal.”

I won’t describe the whole concert, but here are some highlights that make up the best concert experience ever:

• Seats against the barricade, directly in front of Ben
• A brand new camera for stellar pictures
• A perfect mix of old, new and fake songs
• A nine song encore that even had an encore of its own
• Being one of two people to shake Ben’s hand after the show
• Receiving the encore set list
• Waiting out back for a picture with Mr. Folds afterward

My voice was hoarse, but I enjoyed each little remembrance of the concert that accompanied me to UTSW’s White Coat Ceremony. In contrast to most medical schools, Southwestern waits until their students survive the first two months before bestowing the symbolic white coat. A reward for completing the high test density of mid October, the warmth of both the long sleeves and accompanying family was a welcomed relief. I was lucky enough to be joined by both grandmas, parents and younger brother. (unfortunately, Caroline had a Saturday packed with a cross country meet in the morning followed by homecoming in the evening)

Our dedicated administration pulled out all the stops, making for a very memorable afternoon.  After sitting through an hour of ‘knighting’ and being showcased in wet scubs for all to see, I will always remember slipping my arm through the clean white sleeves.  While only a piece of white cloth, the coat automatically spurred some changes; med school finally felt like med school (especially with biochemistry out of the way), our pretend doctor costume was actually believable, we had a place to store our $400 diagnostic kits and stiched names seemed to cement our place in medicine.  Unfortunately, the coat doesn’t come with an urge to crack open my genetics textbook for a rousing discussion single-gene inheritance.  This I’ll have to do myself…

Woah . . . what just happened to September and October?

A part of me always knew that this whole med school thing would try to consume my life.  Now that part is saying, “I told you so.”  The past two months felt less like school are more like trying to find my way through a foreign city after pre-pinata treatment.  Luckily, after two months, besides being able to recite stereotypical biochemical pathways or describe your head/arm inside and out, I feel like I’m navigating sans blindfold and post-nystagmus.  What a journey this will be!

How about a little background information?  The period that precedes my current free time is scornfully termed “blacktober” by my esteemed peers.  Why tarnish the good name of a wholesome month like October you may ask?  Well, when you sandwich an anatomy mid term lab practical between an anatomy lecture mid term and biochemistry final exam (within the span of 7 days), the term stressful no longer applies.  When I found time to take a break from biochem, it really turned out to be the perfect opportunity to revisit those 40 anattomical structures from the previous day’s dissection (or do things like eat and sleep).  The week following biochem, I took a step back for a deep breath, but all I smelled was formalin.  Anatomy officially became my home away from home and as inspiring and captivating as the anatomy lab is, I’d still rather live with the living.

After these brutal weeks, I do believe I have extracted a number of important personal lessons:

1. How to study
   Cramming for tests the night b efore no longer works, but try cramming for tests the weeks before and you’ll be ok.  Also, forget just going by what is said in lecture.  Instead just go ahead and memorize that minute fact in the right-hand corner on page 67 of the syllabus, it’s testable.
    
2. What’s required for the coveted A
   You’re in med school and chances are you have a classmate that studies during most waking moments.  Either that or they’re just inherently knowledgeable on the pathogenesis of gout or the stepwise mechanisms of metabolism.  Nonetheless, you’ll work harder than you’ve ever worked, but you might do worse at the same time.  Don’t worry, these are the side effects of amassing 250 of your best competitors and as they say, at the end of it all, you’re all called the same thing . . . doctor.
    
3. What makes healthy medical student (person in general)
   More than ever, balance is key.  Play some intramural volleyball (2nd place baby!), cook a meal for yourself or go out to a show, happy hour, the symphony or a Ben Folds concert (this Thursday!).  Just don’t forget that you’re not working towards a life in medicine, you’re living a life in medicine.
    
4. What makes an unhealthy med student (person in general)
   Besides the ill effects of smoking through dissections of blackened lungs or drunk driving through pictures of trauma victims, medical school teaches some unhealthy habits of its own.  Students live a life of extremes; intense spans of studying followed by intense spells of drinking.  Be conscious of hypocritical tendencies (i.e. criticizing/counseling patients about their poor decisions while making your own).  (and yes, I know doctors are still only human)
    
5. Medicine is the place for me
   Amid a somber tone from 4, medicine is absolutely amazing.  The secret workings of the human body and soul are at your fingertips.  Diseases and maladies of the body become explainable mechanisms, all curable once fully understood.  As I drive to class each day and look at the world around me, I can’t help but feel ultimately privileged to study medicine and I hope you feel the same way (in whatever you may do).
    

As I go through the next four years, I’ll continue to expand and manipulate this list stored in the back of my mind.  There’s a lot to learn in the coming months and as long as I help this blog fulfill it’s codifying destiny, I’m ready.

After saying it about 20 times this week, why not another?  I can’t believe it’s here . . . I am officially a full-blown medical student!  This weekend, about 250 of my new classmates and I hopped in a bus down to Glen Rose, Texas for UTSW’s inaugural orientation retreat.  Implemented to replace a rumored hellish lecture orientation, this years retreat was a great -1st weekend of medical school.

It all started with a two-hour bus ride (45 min according to mapquest) filled with 3-minute speed meeting sessions.  If you feel like drying out your vocal cords, get about 40 new friends, a three-minute timer and take a deep breath.  Upon arrival, we had a quick small group session and an afternoon of old-fashioned free time.  Just picture 250 soon-to-be-docs playing volleyball, kickball, going on nature walks and of course learning the biochemistry behind baking bread.  But as invigorating as ziplines and camp meals are, the high point of the day came after a full day of guessing, when our college assignments were announced.

At Southwestern, med students are grouped into six colleges named for influential faculty members.  This means that only a select few are lucky enough to become Cary college unicorns.  The only college at orientation with custom-made pink unicorn t-shirts, Cary college MS1s are definitely an impressive breed.

We had a chance to prove our awesomeness that morning with an impressive display in the intercollegiate relay race around the camp.  Despite crossing the finish line first, we were instead deemed runners-up based on some minor rule infractions at the last station.  All in all, the unicorns downed pudding, changed wet scrubs, flipped cups and leap-frogged like pros.

After returning to campus Sunday afternoon, my excitement is higher than it’s ever been.  I am eager to dive into my anatomy tank, aching to crack open the inner workings of the human body and boy I am ready to really get to know some of the coolest people I’ve ever met.  If the next four years are anything like the last two days, I may be one of the luckiest guys around.