Getting Oriented

Two weeks ago we had "Orientation to the Clinical Years" where we endured a week of powerpoint lectures on how to use a pager, how to wash our hands, how it's important to dedicate our lives to our patients...yet retain "balance." It felt like first year orientation all over again --- a little bit exciting, a little bit scary and overwhelming, and a little bit like a waste of time. We also got to practice drawing blood and placing IV's in each other (the fun part!). The week ended with us getting our Grady ID badges and being sent off with an inspiring speech by the dean.

I walked away from orientation with the clear message that "Your life is about to change -- get ready."

Let's hope I am.



P.S. A scarily accurate portrayal of the last two years of my life spent in the classroom: video

Moving a "Step" in the right direction

re·lief/riˈlēf/

Noun:

A feeling of reassurance and relaxation following release from anxiety or distress.

(via google dictionary)

RELIEF...

is the biggest thing I'm feeling after getting the news that I not only passed Step 1 of the USMLE boards, but that my score was where I wanted/needed it to be for future career options.

The whole process of studying for the boards wasn't too stressful in itself, but the 3 weeks waiting for my score filled me with anxiety. The day before and the day after the test are definitely the worst, but it's over. I'M FREE!! ... until Step 2 at least ;)

More than epicanthal folds and simian creases

The way we learn to think about Down Syndrome for the boards is as follows:

"mental retardation, flat facies, prominent epicanthal folds, simian crease, gap between 1st two toes, duodenal atresia, congenital heart disease, associated with increased risk of ALL and Alzheimer's Disease. ~First AID for the USMLE Step 1

Nella shows a different side of Down Syndrome...

Nella's video

Dear Patient X, Thank You

As I'm studying for the boards, I've realized how great an impact a face for a disease makes. For every disorder where we had a patient presentation, I remember the specifics of the disorder so much more easily. It makes me appreciate it so much more that Emory incorporates these patient interviews into our curriculum because it makes me a better student and eventually, a better doctor.

Every time I see tetrology of fallot, I think of the friendly woman with the bright green outfit that told us her story about being a "blue baby"

Every time i see pulmonary hypertension, I think of the cute young woman telling us the intricacies of her medication routine.

Every time I see Fanconi's syndrome, I think of the mother coming in with her son telling us about his disorder.

Every time I see ARPKD, I think of Julia and how she found out that both of her kids have this disorder when pregnant with her second child.

Every time I see ALL, I think of those sweet parents coming in to tell us the story of their precious baby girl and the fight she fought for her only 2 years here on Earth.

So, to all those patients who came in and were willing to share their stories with us, thank you.

A Poem: USMLE Step 1 Boards Studying

Twas the month before Step 1, when all through the house
Not a creature was stirring, not even a mouse
The laptop was open, the questions studied with care,
In hopes that answers could now be found there

The cats were nestled all snug on the bed
while I reviewed flashcards; drugs-- please stay in my head!
Clover in his sweater, me in my sweats
going through USMLE World, multiple question sets.

When downstairs from a cat, arose such a clatter
I went down to investigate and see what was the matter
Nothing was there, a ghost perhaps?
or maybe I'm losing my mind after trying to remember SIGECAPS

Mneumonics, mneumonics, mneumonics and more
how many diseases can I possibly remember these mneumonics for?
Cysteine, SAM, carbamoyl -- it's all a jumble
I wish I had time to cook since my tummy is arumble

Antibiotics -- bacteria they kill
Can i remember their uses? I hope I will
Viruses, it's you I really hate
dsDNA, proteases -- oh! you really determine my step 1 fate

Now Albendazole! Now Metronidazole! Now Flucanzole and Diazepam
On, Clonidine! On, probenacid! on, on Indomethacin and Lorezepam!
Into my brain! side effects and mechanisms too!
Oh so many drugs, my mind is turning to goo.

First Aid with chapter introductions to quote
and phrases to help with memorization, rote
NBME practice tests, I only have seven more
Now I only hope I can significantly increase my score

I exclaim, as I study on, only more diseases in sight
"January 19th -- it will be all over!", and over it already, I am this night.

A Drop in the Bucket?

Today I attended a lecture on an OB/GYN physician's experience in South Sudan promoting and teaching family planning. She spent 4 weeks teaching local healthcare workers, midwives, and doctors everything from basic anatomy to how to implant an IUD. Her talk highlighted many of the difficulties in global health work such as financial obstacles, language obstacles, and cultural obstacles.

One hospital (term used loosely -- a few 1 room/1story buildings on the same property) where she worked didn't have much/any materials and medication. The hospital pharmacy and THREE small bottles of antibiotics. They didn't have sutures, speculums, or a constant source of power. If a family needed/wanted a c-section, they would somehow have to find their own supplies to bring to the hospital and hope that there is a doctor there who knows how to do it (not to mention traverse horrible, unpaved road for hours upon hours to get there)

Another barrier she faced was 1) the lack of education on why family planning is important (ex -- why can't you have 11 babies starting when you are 14?) 2) the acceptance of physical abuse as a form of aggression in households. This creates problems when you are trying to provide contraception to a women without her husband knowing (ex -- concerns about husband feeling IUD strings). She would have to start from scratch explaining how baby after baby after baby (especially at a young age) increases the maternal mortality rate and decreases the country's productive output.

Although her lecture was extremely informative and enlightening, I couldn't help feeling discouraged as I left. People like this doctor and my medishare team going to Haiti do their best to make a difference, but in the end, what is really accomplished? She left South Sudan with not a single medical professional up to competency to provide contraception (such as IUD and the arm implant). However, they are about a million miles closer than before she arrived and are continuing training in her absence. What about that hospital that can't even function due to lack of supplies? It just makes me really sad about the whole global health picture in developing countries. I know there are NGOs and non profits trying to fill the gap, but it almost seems like trying to put a bandaid over a gushing wound. What would happen if no one did anything though?

I guess I can only hope that all the drops in the bucket eventually add up to make a significant impact. I also know that I am extremely privileged to live in this country with all these resources available to me when I just as easily could have been another person born in South Sudan, seemingly without hope.

A Caveat on Psychiatric Diagnosis

—"If a man does not keep pace with his companions,
perhaps it is because he hears a different drummer.
Let him step to the music which he hears,
however measured or far away"

. -- Henry David Thoreau (1817-1862)