Thursday, July 15, 2010

trauma!! in the med school lecture hall?!


Personally, one of the interesting aspects of working as an emergency radiologist is hearing the stories of each patient as relayed by the ED physicians.  It not only provides pertinent clues in the search for possible pathology, but also at times can add zest to a long night of mundane ED films.  For example, one evening the flavor of the night was "falls". Practically everyone and their cousin that evening had fallen down and came to pay a visit to the ED.  And thus began the parade of different ED docs handing me some films and giving a variety of one sentence histories:

ED doc:  "Patient fell while playing video games."
TR: saying nothing, but perplexed look on face as this pre-dated the invention of Wii
ED doc:  "Oh, he was drunk."

ED doc: "Fell off balcony."
TR: "Alcohol?"
ED doc:  "Yes."

ED doc:  "Fell off chair."
TR: "Elderly person?"
ED doc:  "Nope, intoxicated."

ED doc:  "Fall from standing."
TR:  "Alcohol?"
ED doc:  "No, elderly patient."

ED doc:  "Fall down 30 stairs."
TR: "Alcohol?"
ED doc:  "No, completely sober.  Young female med student who fell in the lecture hall after a long day of classes."



This last one could have been a true history, my history in fact, if it wasn't for the intervention of a good future friend. 


It was the second week of medical school, a very exciting time, and the end of the day after several hours of lectures.  The lecture hall had a long series of tiled steps probably about 60-70 in total.  I had sat a little more than half-way up, packed up my heavy book bag and notes, and started the way down.  It was thrilling to be in school, but good to know that the long day was over.  After travelling down three stairs, there were two classmates on my right, male and female, chatting alongside the steps.  But as I continued descending, suddenly I realized that my foot was somehow misplaced and had missed the stair. "I'm falling!!" I thought in horror!  My thoughts raced as I teetered on the other step and braced myself for the ugly horrible fall.  Not only would it be very embarrassing but it would also be very painful as well.  It was a long way down, and the steps were hard.  Time stood still.  I heard the female student gasp as she realized what was happening.  But there was nothing I could do, no railing to grab, no way to shield against the fall except with my arms, and not only that but the huge bookbag at my side was a strong weight throwing me forward.


Suddenly, a hand grabbed my arm and pulled me back from the brink.  It was a miracle.  It was the male classmate.  How he was able to be in the midst of a conversation, hear his friend's gasp and then turn and catch me in less than half a second, is still a mystery.  I turned and thanked him profusely, still in shock at being saved from a terrible fall.  His female friend was in shock also, and the two of us looked at each other laughing nervously while acknowledging that significant injury had been averted.  The guy however, was humble and kind, but unaffected. No big deal. Just another day in his life of saving people I supposed.  I walked away from the lecture hall feeling very grateful, but still numb and in shock.

Fast forward to third year, and he and I were on the same rotation together and became friends.  He's a very likable guy, always ready with a joke and making people laugh and feel at ease.  One day we were talking, and the incident with the stairs came to mind.  "You know, you saved my life," I told him, "It was a miracle!" And then related the details.  "Really?!" he said, surprised.  And then in his usual lighthearted candid tone added, "Then it really was a miracle, because I never came to class!"  And we laughed.  He said it so humbly and kindly.  No big deal.  Just another day in his life of saving people.  He became an ED doc, by the way.  How appropriate.  Thanks again Dr. K... 

Please feel free to share if someone has ever saved you from danger or done something positive to better your life.


OMNIA VINCIT AMOR
amara


© 2010 amara/aag musings of a trauma rad

Monday, July 12, 2010

dedication to a patient



It was my first rotation ever in the hospital as a third year med student.  First time seeing actual patients, first time interviewing and examining patients, first time being on the floors and getting used to everything and everyone, and it was a little overwhelming.

This first rotation was inpatient Internal Medicine, and she was one of the first patients I ever admitted.  She was in her 70s or 80s, but her age was probably the least memorable aspect about her.  What was most striking was her vitality, enthusiasm, and optimism.  She was in the hospital getting a work up for stroke, but ironically when I met her, she had full presence of mind, intelligence, and was very engaging in conversation.  She had that certain something that exuded a life well lived-- full of joy, no regrets, and and enjoying life in each moment.  

After performing the history and physical (H&P), we chatted.  She was very interested in me and excited to hear that I was studying to be a doctor.  She was very encouraging and expressed confidence that I would make a good one. Transitioning from the two years of lectures and labwork to seeing patients on the floors, was basically like jumping in an ice cold pool, the contrast was so great. So her enthusiasm and optimism were balms for the awkwardness and uncertainty I was feeling in this new environment.  She expressed excitement for me in this new phase of my life, as well as delight in that I was pursuing a lofty goal.  She told me that she was an archeologist and had travelled to Egypt for work.  She had been married, but did not have children.  And it was evident that she still had childlike curiosity and inquisitiveness.  It seemed to me that she lived her life pursuing what she loved, and enjoyed every minute of it.

I remember the first two days visiting her, and wondering why she was even in the hospital.  She seemed fine to me.  When stopping by to check on her during rounds, we would have lovely little chats, and it was like visiting a wise older friend.   But, then it happened.  On the third day, the intern reported to our team that this patient, my new enthusiastic friend, had been wandering the hallways overnight and had removed her gown.  After hearing the news, I visited her that day on rounds, and she was tired and friendly, but not quite as energetic.  The next day again it was reported that she had wandered the halls, and even became belligerent.  To hear this news was incomprehensible.  I made a visit to her on rounds, and upon seeing her, discovered her hair was disheveled, her gown was in disarray, and she was upset.  "Mrs. so-and-so?", I said tentatively.  She recognized me and answered in her usual self.  But after a few minutes she became very irritated and angry.  It was so shocking that I stared at her in disbelief.  How could this woman who was so sweet, intelligent and poised, now be yelling epithets and be so aggravated?  Then, as if in answer to my incredulousness, for a few seconds, my friend became lucid and with clarity and full presence of mind looked me straight in the eye, and gently said, "I am so sorry."  I began to say that it was okay, and then as if a veil suddenly slipped over her eyes she became belligerent again.  And she was gone.  Forever.

After that moment, she became increasingly confused and agitated. And unfortunately a day or two later, I was moved to a different team on a different service.  The intern on the team took over her care, and complained how difficult this patient was.  The thing is, this female intern had never known her prior to her stroke like I had, and if she had, I'm sure she would have had a greater compassion and understanding for this patient, my friend.  The intern did not have the fortune of meeting this interesting and amazing woman, and only knew her as a "problem" crazy patient, an "old" woman who wandered the halls naked and yelling.  And the huge disparity in her perception of my friend versus my perception really made me think about how often we may misjudge other people and not give them the benefit of the doubt, or make an incorrect judgment by not seeing the whole story.  How easy it is to take a quick "snapshot" of someone at a certain time and place, and pass judgment.  But yet, how difficult it is to look beneath the surface and investigate a little deeper, or give benefit of the doubt to someone who may not be acting the way we would like them to act.  I am so grateful to have had the opportunity to have met my friend and the insight that she gave to me on that first rotation of my medical career.  It's a lesson that has to be practiced and practiced and practiced and practiced, and also remembered, remembered, and remembered.  So, even though we knew each other for a few short days, her impact on my life has been quite significant. She is a reminder to look beyond the surface of things, and to be open and willing to understand. 

So, as this is my inaugural blog, I wanted to honor her by writing about her spirit and encouragement towards a young new med student.  With such a personality as hers, it seems only logical that she probably encouraged countless of people in her lifetime. 


As a med student, intern, resident, fellow and attending physician, you are witness to the gamut of happy and tragic situations that can happen to human beings.  You are privy to intimacies and responsible for the care and well being of others, and therefore, this vocation cannot be taken lightly. To be a physician is an honor and a privilege. 


I would like to thank God first and foremost, for the gift and opportunity of being able to pursue the dream of becoming a doctor; to my parents and brother for unequivocally believing in me and supporting me; to my close friends for being my confidantes and also believing and encouraging me; to my prior attendings and fellowship program directors and attendings for their vote of confidence, instruction, and enthusiasm; to the ancillary and auxiliary staff of the various hospitals who were of assistance and generous and optimistic; and last of all but certainly not least, to all the patients who teach me every day, and enable me to learn more and more in order to help others, with a special note to my friend. I give heartfelt thanks to everyone, and hope and pray to be of benefit and a channel for healing. 

Thank you for stopping by and reading.


OMNIA VINCIT AMOR

amara

© 2010 amara/aag musings of a trauma rad

Saturday, July 10, 2010

the book that's recognized everywhere!


It was late summer in the my first year in medical school, an early Friday evening, and I had just finished several hours of studying at the law library on  "big ten" campus.  A friend and I had arranged to meet for dinner.  So with my book bag bulging and heavy, I walked the couple blocks to the Union and stood outside on the sidewalk waiting and watching all the cars and students pass by.  On the way there, I had taken out one of the heavier books and hand carried it to lighten the load. The book was "Atlas of Human Anatomy" by the venerable Frank Netter.  Love that book!  As I waited, this new favorite book was cradled in both hands, closed shut with title turned discreetly towards me.

So, two guys are walking by, and one of them points and exclaims to me, "Hey!  Is that a Netter?"  And in utter disbelief I reply, "Yes.. it is!"   What in the world??!!  I had purposely turned the book so that my identity as a med student could be concealed. The book was completely black and was marked only by the lettering on the front which simply stated the title and the author's name. Yet somehow a complete stranger took one look and recognized it instantly!  Huh???  Well, turns out they were from Ohio (not that Ohioans have special ESP or anything) visiting a friend on campus and they were also both medical students. Wow. 

Dr. Frank H. Netter, for those in the non-medical field, is the gold standard of medical illustrators.  His book, the "Atlas of Human Anatomy" is required and/or recommended reading in many medical schools, and is not referred to as "the Atlas", but rather the "Netter".  The elegance of his drawings and practical views and dissections have enabled many students in the medical and medical-related fields to learn and understand the anatomy of the human body.  Netter was born in Manhattan, and from an early age had a strong interest in art, specifically drawing, and desired to be an artist.  His parents however, wanted him to pursue something a little more "practical", and thus young Netter matriculated into medical school.  Even then, the interest in drawing had not diminished.  According to netterimages.com, Netter took notes in pictures rather than words, and had also made several illustrations for different lectures and textbooks.  He finished training as a surgeon, but this was the time of the Depression.  Netter was able to make more money by doing illustrations, specifically medical illustrations, and through a series of events, found himself as a medical illustrator.  This twist of fate allowed Netter to effectively merge his love of drawing and background of medicine, thus positively influencing the education of countless generations of students in the medical field!  Amazing how these things happen!

For more info, check out this link:
netter bio

Happy reading!

Anyone have any favorite interesting books to share?  Comments are welcome!

OMNIA VINCIT AMOR
amara

© 2010 amara/aag musings of a trauma rad





Friday, July 9, 2010

the decision to go forward


I remember the semester that I decided I wanted to go to medical school. I was an engineering major, and the thought kept coming again and again to study medicine. It was an attractive idea, and had always been since the time I was a 5 year old kid (until the interest in engineering sidetracked me during junior year of high school). One of the engineering courses that I had recently taken was ergonomics, designing machines and interfaces to fit the human body and psychology, and it was an enjoyable course. But the idea that came to me over and over again was, wouldn't it be much more interesting and fun to actually study the human body instead?

And so for weeks, the idea turned over and over in my head. There were many thoughts that were of a discouraging nature, "You're not smart enough." "It's too late. You've already declared your major as engineering." "The competition to get into medical school is so high." And on and on. But through serendipity, there was a day long course held on campus about applying to medical school giving advice to students who were considering becoming physicians. While attending, I met another student who was very optimistic and encouraging. We discussed our interests in medical school and found in each other positive camaraderie. The course gave me a starting point of what to expect in the application process, and meeting the other student gave me hope. Also, by good fortune, I found a book in the bookstore that really cemented the idea that there was a chance that someone like me could be accepted into medical school. It talked about strategies for applying and gave useful bits of information regarding pre-med requirements and even had sample application essays. Probably one of the most useful aspects of the book were the examples of several students who had made it into medical school under various situations. I carried that book everywhere, and highlighted sentences that gave me inspiration, and read it over and over.

When I look back, it seems so logical and easy, as if step by step, each decision led to another decision, and each action led to another action, all culminating into the final logical conclusion of being accepted and matriculating into medical school. But, when I dig a little deeper, it was actually pretty scary. There was no real guarantee that I would be accepted after taking another year to fulfill the med school prerequisites and another year after that to complete the application process. There was no guarantee of doing well in the pre-med courses or MCAT examination to garner any interviews. There was no guarantee that all of this time spent studying and applying would lead any closer to becoming a doctor. Sure, the engineering degree was a possible "back-up". But, it wasn't a true viable option because what I really desired was to become a doctor and nothing less. However, once that decision was made, although in my heart it was right, it definitely felt like stepping into a huge black hole. There was no way to see ahead, no way to have sure footing, no way to know that the dreams could be fulfilled. There were no guarantees whatsoever. It was terrifying at times, especially the not knowing. But, it was also exciting because the classes were enjoyable and interesting, and leading me to my dreams!

Some of the hardest times were when I knew what needed to be done, but fear and worry momentarily stopped me from moving forward. It reminds me of the first (and last!) time I ever went indoor rock wall climbing. I'm scared of heights, but tried it anyway, and happy to say I made it to the top! One of the significant keys of that success was the instructor, and what he had said. There was a point where I was three-quarters of the way up the wall. The top of the wall was in sight, and possible to attain. The ground was a long way down though, and also very easy to attain in one small slip. My friends called to me, "Don't look down!" I was scared. Frozen. There was no definite new foothold or hand hold, and I was stuck. The instructor yelled to me, "Step up! Just step up!" And through the calm authoritative confidence in his voice, I was able to realize that he was right, and all I had to do at that point was take the one leg that was bent and positioned on a foothold, and put my weight on it and step up higher. Using his advice and my friends' advice, the climb to the top was successfully accomplished.

And so it was also that way in applying to med school. Times where ruminating over the unknown future, the possibility for failure or rejection, etc etc left me frozen and paralyzed. But then something or someone or even myself would analogously yell, "Just step up!" and it would be enough to help me take the next action, fill out the form, keep studying, request the recommendation, etc. I'm very grateful to the people who knowingly or unknowingly did this because applying to medical school was a daunting task, at least for me. And it seemed like a huge risk because it was a big dream to pursue. So, what I would like to share with those of you that are pursuing a dream is this: if you
run into a snag, or start to get anxious, take a deep breath, and take a step forward, even if it is a little one. Make that phone call, fill out that section of the application, inquire about that class.. You might feel as though you are in a dark room because you can't see necessarily where it will lead, and you may question what use is it to make even the tiniest of steps forward, but be persistent. Soon those little steps will add up and lead you into the light of day where you can reach your goals and dreams. And then when you look back it will seem to you that everything had a logical step and a reason, and then you will be encouragement to others on their path to their dreams.



Please feel free to share any stories you might have of accomplishing "impossible" dreams.

OMNIA VINCIT AMOR


amara

© 2010 amara/aag musings of a trauma rad

dedication to a patient



It was my first rotation ever in the hospital as a third year med student.  First time seeing actual patients, first time interviewing and examining patients, first time being on the floors and getting used to everything and everyone, and it was a little overwhelming.

This first rotation was inpatient Internal Medicine, and she was one of the first patients I ever admitted.  She was in her 70s or 80s, but her age was probably the least memorable aspect about her.  What was most striking was her vitality, enthusiasm, and optimism.  She was in the hospital getting a work up for stroke, but ironically when I met her, she had full presence of mind, intelligence, and was very engaging in conversation.  She had that certain something that exuded a life well lived-- full of joy, no regrets, and and enjoying life in each moment.  

After performing the history and physical (H&P), we chatted.  She was very interested in me and excited to hear that I was studying to be a doctor.  She was very encouraging and expressed confidence that I would make a good one. Transitioning from the two years of lectures and labwork to seeing patients on the floors, was basically like jumping in an ice cold pool, the contrast was so great. So her enthusiasm and optimism were balms for the awkwardness and uncertainty I was feeling in this new environment.  She expressed excitement for me in this new phase of my life, as well as delight in that I was pursuing a lofty goal.  She told me that she was an archeologist and had travelled to Egypt for work.  She had been married, but did not have children.  And it was evident that she still had childlike curiosity and inquisitiveness.  It seemed to me that she lived her life pursuing what she loved, and enjoyed every minute of it.

I remember the first two days visiting her, and wondering why she was even in the hospital.  She seemed fine to me.  When stopping by to check on her during rounds, we would have lovely little chats, and it was like visiting a wise older friend.   But, then it happened.  On the third day, the intern reported to our team that this patient, my new enthusiastic friend, had been wandering the hallways overnight and had removed her gown.  After hearing the news, I visited her that day on rounds, and she was tired and friendly, but not quite as energetic.  The next day again it was reported that she had wandered the halls, and even became belligerent.  To hear this news was incomprehensible.  I made a visit to her on rounds, and upon seeing her, discovered her hair was disheveled, her gown was in disarray, and she was upset.  "Mrs. so-and-so?", I said tentatively.  She recognized me and answered in her usual self.  But after a few minutes she became very irritated and angry.  It was so shocking that I stared at her in disbelief.  How could this woman who was so sweet, intelligent and poised, now be yelling epithets and be so aggravated?  Then, as if in answer to my incredulousness, for a few seconds, my friend became lucid and with clarity and full presence of mind looked me straight in the eye, and gently said, "I am so sorry."  I began to say that it was okay, and then as if a veil suddenly slipped over her eyes she became belligerent again.  And she was gone.  Forever.

After that moment, she became increasingly confused and agitated. And unfortunately a day or two later, I was moved to a different team on a different service.  The intern on the team took over her care, and complained how difficult this patient was.  The thing is, this female intern had never known her prior to her stroke like I had, and if she had, I'm sure she would have had a greater compassion and understanding for this patient, my friend.  The intern did not have the fortune of meeting this interesting and amazing woman, and only knew her as a "problem" crazy patient, an "old" woman who wandered the halls naked and yelling.  And the huge disparity in her perception of my friend versus my perception really made me think about how often we may misjudge other people and not give them the benefit of the doubt, or make an incorrect judgment by not seeing the whole story.  How easy it is to take a quick "snapshot" of someone at a certain time and place, and pass judgment.  But yet, how difficult it is to look beneath the surface and investigate a little deeper, or give benefit of the doubt to someone who may not be acting the way we would like them to act.  I am so grateful to have had the opportunity to have met my friend and the insight that she gave to me on that first rotation of my medical career.  It's a lesson that has to be practiced and practiced and practiced and practiced, and also remembered, remembered, and remembered.  So, even though we knew each other for a few short days, her impact on my life has been quite significant. She is a reminder to look beyond the surface of things, and to be open and willing to understand. 

So, as this is my inaugural blog, I wanted to honor her by writing about her spirit and encouragement towards a young new med student.  With such a personality as hers, it seems only logical that she probably encouraged countless of people in her lifetime. 


As a med student, intern, resident, fellow and attending physician, you are witness to the gamut of happy and tragic situations that can happen to human beings.  You are privy to intimacies and responsible for the care and well being of others, and therefore, this vocation cannot be taken lightly. To be a physician is an honor and a privilege. 


I would like to thank God first and foremost, for the gift and opportunity of being able to pursue the dream of becoming a doctor; to my parents and brother for unequivocally believing in me and supporting me; to my close friends for being my confidantes and also believing and encouraging me; to my prior attendings and fellowship program directors and attendings for their vote of confidence, instruction, and enthusiasm; to the ancillary and auxiliary staff of the various hospitals who were of assistance and generous and optimistic; and last of all but certainly not least, to all the patients who teach me every day, and enable me to learn more and more in order to help others, with a special note to my friend. I give heartfelt thanks to everyone, and hope and pray to be of benefit and a channel for healing. 

Thank you for stopping by and reading.


OMNIA VINCIT AMOR

amara 

 

when enough is enough



A friend and I met for dinner several months ago, and as part of our conversation she mentioned an artist and her work that she happened to see in a local museum.  The artist was in her 70s and her work was primarily focused on traumatic events that occurred during her childhood.  My friend discussed the interview of this artist and her work, and while she discussed the details, I could not help thinking, "Wow, that is a long time to keep remembering the hurts of the long ago past, and this artist is in her 70s and still thinking about it!?"


Just when is enough, enough?


Ironically, at the time, I had been going through a grieving process of my own: the loss of four very close friends, two of whom had betrayed me and had been in collusion against me.  It was shocking and deeply hurtful.  Almost three years had passed since the whole episode imploded and I was left alone holding the bloody bits and pieces.  And I was still furious.  Rage, discouragement, depression, desire for revenge, victimization... all these thoughts and more kept lurking in the back of my mind. "Justice!  Where is the justice?!" was a nightly mantra while ruminating over past hurts.


The whole situation with those former friends was completely over and done. There was no chance whatsoever of reconciliation.  All the bridges had been burned long ago.  But somehow, it seemed as though by reliving the episodes over and over again, that vindication would come, and peace and closure could then ensue.  


NO. It never did.




I don't mean in any way to disregard the pain that this woman suffered.  And obviously, childhood traumas can be very damaging because children don't always have the tools to be able to process what happened. Heck, emotional and physical trauma at any age can be very difficult.  But, what saddened me initially, was that this woman who has lived more than 70 years on this earth still goes back and back and back to the painful past. Surely with each work, it must bring those past hurts alive again in her memory.  It seems so tragic and almost wasteful. To define her life by her traumatic childhood somehow dampens the beauty and joy that she could potentially find in her wonderful Present. 


The artist and I were basically doing the same thing.


Her life was a definite sign to me that enough was enough.




OMNIA VINCIT AMOR
amara

© 2010 amara/aag musings of a trauma rad

Thursday, July 8, 2010

passing gas is a normal bodily function



It happened one day during morning report.  

The Rotation: inpatient Pediatrics.  
The Players:  Attendings, senior residents, residents, interns and medical students.  
The Time:  approx 7 am.  
The Place:  a small room in the hospital, with the door closed for privacy, of course!


As I recall, it was the beginning of morning report and one of the residents gave a summary of a patient that was admitted overnight.  And then there was a pause. Not a super long pause, but unfortunately for someone, it was more than long enough.  And this someone let loose --- a loud single staccato.  Certainly not me, of course! I was just an innocent intern minding her own business.  But this was so loud and unexpected that I couldn't help it, and laughed out loud.  Another female intern heard it also, (well actually, who wouldn't have heard it?!) and laughed out loud too.  We looked at each other, and then quickly stifled our giggles because NO ONE else was laughing.  Everyone else was DEAD SILENT.  The whole room was FROZEN.  It was complete DENIAL.  And then, morning report continued as though nothing had happened. La, la, la...

Yes, I do have an immature sense of humor at times.  And it still makes me laugh when I think about it.  

The whole irony though is that you'd think a room full of doctors who are used to seeing all sorts of bodily fluids and etc escape from all sorts of orifices, natural and unnatural, and from smelling all sorts of various odors, and from seeing people of all ages in various stages of undress, would be comfortable in the sonorous passing of a little gas.  

Yes, I am immature.  And you know what, the thought just occurred to me...  Maybe it was one of the attendings ?!

Anyone have any true funny and embarrassing G-rated stories to share?  Comments welcome!


OMNIA VINCIT AMOR
amara


© 2010 amara/aag musings of a trauma rad