Life as a Patient

Finally nearing the end of my hospital stay, I have gleaned a great deal of information and experienced my share of ups and downs. Surgery was a difficult experience as it left me with pain, wounds, and the after effects of anesthesia. Being in the ICU with all of its high-tech glory was much less fun than I remembered from rounds.


Post-Operative Recovery

Fortunately, I was able to avoid catheterization. Nonetheless, the anesthetics had a long lasting effect that disturbed both my gastrointestinal and urinary tracts. Every time I tried to drink fluids, my stomach would have nothing to do with it. I had to keep the emesis container within reach as there was no way of judging how my body would react. It was more annoying than anything as the cottonmouth was rather unpleasant. Between medicated naps and side aches from my freshly placed chest tube, all I could do was wait for the anesthesia to wear off with my barf bag in hand. Learning to adjust to my new wounds and pains was going to take some time, and all I could do was wait. As the clock rolled, I became hungrier and dared to try solids. It tasted good, went down well and sat well...but only for 10 minutes. It was then that I wished I had an emesis bag the most; a simple device I could put on and forget about. Luckily, it became easier to hold the food in and now I had to get my bladder to cooperate. With some serious concentration, faucets running and a friendly coaxing from my visitors, the bladder situation was overcome in due time.


Little did I know that the next few days would be worse. Inflammation, muscle aches, tubes, wires, medications and the list goes on. Now I was starting to understand what my post-operative patients had been experiencing. From one unpleasant experience to the next, I was now on the doctor's schedule awaiting instructions and decisions. My job was to report any problems, stay attached to all my wall connections, exercise my lungs and generally get better. I was happy to hear I was the most stable patient on the ward, which was to be expected as I was also the youngest. The TV was boring, my neighbor's moans annoying and the food not always appetizing. Getting up and walking around the unit was the most enjoyable activity I participated in during my stint. Something we so easily take for granted had now become the highlight of my day. At last discharge is in sight and I can soon recover in the comfort of my own home. This experience, however, has made a significant impact on my perception of health care and the way I intend to approach my future patients. What a great way to spend my vacation month.

Question of the Week

As a new patient on the surgery ward you are asked by the dietitian make your next meal order. Which of the following will have the worst effect on your health and recovery?

A. Turkey roast with mashed potatoes and broccoli
B. Chicken fingers and French fries
C. Meatloaf with mixed vegetables and a dinner roll
D. Shrimp pasta alfredo with garlic bread
E. Chicken salad wrap with clam chowder soup


Answer & Explanation

Finding Pneumo

Excited to finish my last core rotation and move on to my first elective, I wanted to make a quick stop at the doctor's office for a prescription. Unfortunately, the cough I had was not readily treatable by prescription and would have to be further evaluated at the hospital.

The "Patient" Rotation

Reluctantly, I made my way to the hospital to have the spontaneous pneumothorax treated. A chest tube and days later I still find myself suction tied to my room awaiting a change in pulmonary status. The first time I was given oxygen I almost recoiled as though they intended it for another patient and must have made a mistake. The nurse responded and said, "it's hard to be a patient, huh?" The truth is that I don't know what it is like to be a patient. Over the last few months I have been contemplating what it must be like to be stuck in the hospital bed waiting for providers, asking for medications and not on your own turf. What do patients feel with certain medications? How do they manage to clean up on their own? Is the patient food worse than the food medical staff get? Does it really take that long for call lights to be answered? Now I am learning first hand what patient life is really like.

Because of the suction device attached to the wall, I get a moving radius of 15 feet, almost like a dog tied to a stake in the yard. No walks in the hall and I can't even get to the other side of my room to use the waste bin. Fortunately, I have a window overlooking The Strip and the sun shines in its little square of heaven for a few hours every day. Despite an occasional delay in response to my call light, I've been very well cared for. Perhaps it has helped that I am a medical student and the staff are potentially peers. Perhaps they are just that good and I have been lucky to have such nice help. Either way, every part of this experience is new. There is no doubt in my mind that this short stint of time is teaching me more about medicine than I could ever learn in my medical training.

I am not refusing the experience or wishing it wasn't me. Rather, I am accepting it as an opportunity to learn what the other side of being a doctor is all about. I want to absorb it and unfortunately eat, breathe and sleep it. One thing is certain, patience is mandatory, both with self and others. It is not an easy process with  ups and downs around every corner. I was looking forward to starting a new rotation tomorrow in Emergency Medicine at an out of state facility. Plans have changed and I may no longer have that experience, but I feel it has been replaced with an experience just as meaningful. 

Question of the Week

Which of the following statements is true regarding spontaneous pneumothorax?

A. Primary spontaneous pneumothorax typically occurs in tall, thin, older adults.
B. The definitive treatment of a pneumothorax involves the placement of an intercostal drain.
C. Catamenial pneumothorax typically occurs during the end of menses when a patient is taking oral contraceptives.
D. Hemothorax occurs in up to 20% of patients with spontaneous pneumothorax.
E. Pleurectomy is preferred over mechanical pleurodesis for recurrent pneumothorax.

Answer & Explanation

Fetal Development

I remain in awe that a body can reproduce its genetic code and create life as seen in this video.

The Making of Mothers

Preheat the oven to 98.6 degrees, place it in the endometrial wall and let it slowly rise over the next nine months. If only fetal development were that simple. Below are some of the highlights of embryologic formation with which most people never really become acquainted. Welcome to life as a medical student.

First Trimester - Weeks 1-14

• Week 1: Fertilization, morula, blastocyst(Day 5), endometrial implantation(6) and hCG from the syncytiotrophoblast
• Week 2: A bilaminar disc forms(8) and uteroplacental circulation starts(13)
• Week 3: The primitive streak is evident and the central nervous system begins via the notochord and neural plate; appearance of somites(20)
• Week 4: The neural tube closes leaving cranial and caudal neuropores(23), limb buds develop(28), and the heart begins to beat
• Week 5: Facial development, pharyngeal arches and clefts take shape
• Week 6: Fingers start to appear(38), endodermal derivative development (lung, stomach, pancreas, intestines, liver, gallbladder, urinary bladder)
• Week 7: Toes develop, maxillary and medial nasal swellings fuse to form upper lip
• Week 8: Fetus has the appearance of a baby and begins to move; heart sounds can be heard
• Week 9: Eyes and ears form as face and other organs continue development
• Week 10: Male and female genitalia are identifiable
• Weeks 11-14: Fine hair (lanugo) starts to appear; muscle and bones develop

Second Trimester - Weeks 15-27
The bones begin to harden, finger and toe nails form while the fetal organs continue to develop. Movement can be felt during this period as the fetus kicks, rolls, sucks its thumb and learns to swallow.

Third Trimester - Weeks 28-40
The fetus will double or triple in weight from now until birth. The skin thickens with a layer of fat to maintain body temperature. The senses of hearing, vision, touch and taste are developed and used. Repositioning in the womb is not uncommon in preparation for delivery.

Birth
All I can say is that without it, I wouldn't be here. Thanks Mom, Happy Mother's Day.

Board Prep Question of the Week

A male infant has a cleft lip on one side that does not involve the alveolar process or the hard palate. A unilateral cleft lip results from the failure of which two facial prominences to merge?

A. Lateral nasal and maxillary
B. Left and right medial nasal
C. Maxillary and mandibular
D. Medial nasal and maxillary
E. Lateral nasal and Medial nasal 

Answer & Explanation

Basic Life Support

Nearing the commencement of our clerkship rotations, we eased our way back from spring break by receiving training in basic life support (BLS) also known as CPR.

Cardiopulmonary Resuscitation

You never know when you are going to need CPR. For that reason alone, it is wise to at least have some understanding of what to do in an emergency situation. Despite learning the skills, I always seemed to have a difficult time counting the 30 compressions in a real situation. Fortunately, when there are other providers available, the actual count is not as significant as when you are alone.

My experiences in the emergency department have prepared me well for this sort of training. Looking back, I would say that working in the health care setting before coming to medical school has helped more than anything else. Exposure to real situations, with real people makes a significant difference when learning the skills needed to succeed. For this reason, we spend a large portion of our time in the clinics honing clinical protocols and learning the standard of care. As we said in boy scouts "Be Prepared." CPR is a skill that is never to late to learn.

Board Prep Question of the Week

A 70 year old man was brought in the hospital by ambulance subsequent to chest pain that lasted 40 minutes. In order to assess the degree of stenosis of his coronary arteries, he underwent coronary angiography, a procedure during which a contrast dye was injected in his coronary vessels. To which phase of the ventricular action potential does visualization of the stenotic lesion correspond?

A. Phase 0
B. Phase 1
C. Phase 2
D. Phase 3
E. Phase 4

Answer & Explanation

Second Exam Week Two

Other than missing out on the Black Eyed Peas and U2 concert up the street, studying for our exams this time around has been similar to those in the past. Thank goodness, it is starting to become a familiar process that has an end in sight.

Medical Knowledge

Knowing that after the last exams I realized a need to change the way I approach my studies, I am hoping that the change for the better has occurred. In the last few weeks we have had enough quizzes in class to "force" the information in our heads early. For better or worse, it leaves us with a simple review of the concepts at this stage, thus allowing more time for novel material and difficult concepts.

After talking with a few of my colleagues, we were happily surprised by how far we have come. One year ago we would not have been able to carry on a conversation concerning our current material with an understanding of the terminology or concepts. During this second year of medical school there has been a significant increase in vocabulary and conceptual development that builds a stable foundation for medical comprehension. We are only beginning the year, so I imagine there is a lot more to learn, but for the time being we enjoy knowing that all this studying is paying off.

Board Prep Question of the Week

A 44 year-old obese woman who has been recovering from a knee sprain develops sudden shortness of breath and left-sided chest pain with inspiration. On exam, HR is 110, RR is 24, Temp is 37 C, the pulmonic portion of the second heart sound is accentuated, 3 cm of JVD is appreciated, and the right leg is slightly swollen and tender. Trachea is midline and lung sounds are equal bilaterally without wheezes, rales, or rhonchi. The remainder of physical exam is unremarkable. If pathological examination was performed, what would be seen in the affected lung tissue?

A. Caseating necrosis with acid-fast bacilli
B. Exudative consolidation with numerous Gram-positive cocci
C. Hemorrhagic wedge-shaped infarct
D. Loss of alveolar septa
E. Pale infarct at the periphery of the lung parenchyma

Answer & Explanation