Rest in peace, sweet balloons

Remarkably, we are half-way through our first semester. Despite the joy and anticipation of the recent White Coat Ceremony this past weekend, the semester itself has been a spasmodic convulsion of stress and study interrupted by the infrequent, brain-squeezing exam. At this point, I daresay that people who go to medical school must be the worst kind of masochists, myself included.

The sad reality is, though, that I love this. I love the stress. I love the pressure. I love the learning and I love (did I mention love?) the fact that we are being molded, through this fiery crucible, into physicians. It gives me an anticipation for the future and reminds me that, despite my many years, this old dog can be taught new tricks. The suffering is oddly encouraging.

With that, I give you the following two videos: two more balloons have passed from this world to the next, marking the completion of another couple of difficult medical school exams. 

They were good balloons. May they rest in peace...

That terrific, terrible White Coat

Today was our White Coat Ceremony, at time when, at long last, we as medical students receive our short white coats. Though most medical schools usually grant this privilege to incoming students right after the beginning of their first year, at LMU-DCOM we must work successfully through half of the first semester before receiving this honor. And an honor it is! How smart and professional my colleagues and I looked as we took the Osteopathic Pledge today (you can read the pledge here), bedecked in our new gleaming medical smocks, our mouths forming the words that would direct and guide the rest of our professional medical careers, said in the company of hundreds and hundreds of witnesses. 

All of because of that white coat.

What is this coat that casts such a sudden and startling shadow over my life? It is merely polyester, a gift to me from the Tennessee Osteopathic Medical Association, a thin, ill-fitting garment that has the seal of my medical school and, above this, my name neatly embroidered over the left pocket. 

Over my heart.

This is no mere coat. This is a symbol. A powerful, moving, driving emotional force that represents something so much bigger than myself that the very thought of it is at once inspiring and terrifying. I am now, officially, part of the world of medicine. No more MCATs, no more stiff competition for admission, no more uncomfortable interviews or carefully worded essays seeking the favor of medical school administrations. I'm part of the team. I've been admitted to the ride. And, as I'm slowly molded into a physician, I am ever more aware that I am not here because of my extraordinary talent or intelligence (neither of which I have in any great abundance), but because of the grace of God and the support and sacrifice of so many, many people, my family being foremost in this group. This is part of the reality of the White Coat.

In like manner, the coat is a message to our society. By wearing it I am telling people that I am available to care, eventually to heal. That I have sacrificed my life entire for the health and welfare of strangers. That I am no longer my own. That I am determined, wherever I find suffering, to do my best to alleviate it. That I willingly accept the tremendous burden and unspeakable privilege of becoming a health care provider. It is a sign of accomplishment and a reminder that there is so very much more to do. Every day, when I put it on, I need to be aware that I stand on the shoulders of many who have come before and that I have an obligation to prepare the way for those who will come after. 

That damn, delightful White Coat. May my colleagues and I be found ever worthy to wear it.

I Wish I Were an OSCE Meyer Wiener...

Tomorrow is our first OSCE test. OSCE stands for "Objective Structured Clinical Examination" and is the first time that we get to officially play doctor. We will be given a simulated patient (an actor or actress) with simulated vital signs and a simulated medical problem. We have 18 minutes to properly greet the patient, establish some semblance of rapport, clarify the chief complaint, get a pertinent history, conduct a physical examination, and provide a differential diagnosis ("I think you may have..... THIS, this or THIS"). The entire time a proctor will be hovering over us and grading our every decision. Most of the young people, my esteemed colleagues, are quite nervous about tomorrow, as very few of them have ever done anything like this. For myself, I did this in the Army for about 18 years. I'm not nervous at all!

Sort of...

In the Army, I had the opportunity to see hundreds and hundreds (and hundreds) of patients with pathologies of nearly every kind. In those experiences, though, I was the medic. I would greet, screen, stabilize, sometimes diagnose (with a doctor around), and treat. Tomorrow, I'm going into that room as a student DOCTOR. In other words, there is no one higher up the chain to blame if I mess up! Though I am only in the first semester of medical school and have a very, VERY long way to go, I am being given a taste, however small, of my future for my patient tomorrow will be looking to me, and me alone, for help to heal their ailment. They will expect me to know what I'm doing and to do it in a manner that is smooth, compassionate, and competent. They will be looking for a man both educated and sympathetic, a balance of Einstein meets Mother Teresa. I'm suddenly feeling very small. Doubts begin to ping around in my head like so many billiard balls: what if I don't measure up? What if I forget something important? What if (and this is my biggest fear, God forbid), what if I hurt the patient? Primum non nocere never weighed so heavy. 

In the end I know that tomorrow is simply a test of skills thus far developed, that the person in front of me will be a paid actor, and that it will all be over in a few minutes. What tomorrow means to me, though, is that I am growing up to become a physician, one who is being trained to care for hurting humanity. I'm beginning to sense a passion for people and a love of learning I've heretofore never known. And I am reminded that there are few greater joys than to help the hurting. 

Bring it on!

                                                   Image Credit: Ronald Harden (r.m.harden@dundee.ac.uk)

Of Art and Science

It is little secret that I am a "Type A" personality. Like most of my colleagues in school, I like to be on top, in charge, and "the best". Admittedly, pride is a great propellant of this personality and, as a Messianic Jew, I understand that such an approach to life is often less than godly. I am working to change this.

It is this "Type A" attitude, then, that recently caused me some rough feelings. Today was our first OPP practical exam (osteopathic principles and practices - click here for more information). Like my fellows, I studied hard and practiced the healing therapies that we have thus far been taught. I went into the test feeling confident. And, though I have every confidence I passed, I did get one question wrong.

One.

And my "Type A" kicks in......

How could I have missed that one question? It turns out that I didn't get it wrong - at least apparently. A few weeks ago we were practicing our OPP and I was corrected by a kind and knowledgeable instructor. "This is how you do it, Troy, not that way." I was grateful and moved on. Today, as you can predict, I was given the same situation and I presented the answer as I was corrected. To the horror of my anal personality, I was told that I was wrong. What??!! my mind rebelled. I politely tried to explain to the grader my predicament. He would have none of it and thus I missed the question.

To whom should I listen: the teacher from a few weeks ago or the grader today? This quandary demonstrates an eternal truth about medicine - it is as much art as science. What may be true for one practitioner may not be true for another and what may work to heal one patient may injure another. This truth makes medicine an incredibly difficult career. Add to this the reality that human lives are at stake and the pressure is on. So, don't be too hard on your health care provider. It is likely that they are trying their best and, like all people, may make the incidental mistake or two. Hopefully it will not be a serious mistake and hopefully all will be able to learn from it.

Meanwhile, another test is over. Here is the video of the victorious balloon blast. Thank God, another one down! :)

God bless you, dear reader. As for me, it's - back to the books.

Killing Balloons

It is a truth that none of the information being presented at medical school is difficult in and of itself. The real challenge is the quantity of data. I don't know how many times in the past month I've heard "It's like drinking from a firehose". For me, it's more like being asked to imbibe the Pacific Ocean in all its entirety (see The Five Chinese Brothers by Claire Huchet for more about this!). Because of this extraordinary demand, tests become a source of anxiety. We know when they are coming (click here to see our schedule this semester) but, despite heroic attempts at studying, every test feels like an approaching tsunami. This being said, every passed test becomes in itself a victory. To celebrate, I use a BB-gun and shoot a balloon with the number of the test on it. Being retired from the US Army, I find this ceremony oddly satisfying. As of this writing, we are two tests down with many more to go. It's going to be an adventuresome Fall semester! Below is a brief video of my most recent test balloon.  Enjoy....

Friday Afternoon Musings.....

Remarkably, today marks the end of the fifth week (counting "zero week". See the earlier post) in medical school. I know that there is a very l-o-n-g road in front of me, but this milestone gives me pause.

It's a strange place, medical school. On one hand, five weeks have literally whizzed by, as every day is filled with exponentially greater amounts of information to digest (more about this in a minute). On the other hand, these past five weeks have been the longest in my life, as there are exponentially greater amounts of information to digest....

I've learned that "becoming a doctor" is much more than memorizing facts or sweating out tests. Becoming a doctor also involves learning how to deal with stress, manage time wisely, and function well under pressure. Medical school is not simply an academic exercise, it's a behavioural one, teaching us how to live lives that are focused and disciplined. After all, one day we will have human lives in our hands. I am learning to love the heat and pressure of school, knowing that it's preparing me for the future.

Thus far we have finished two written exams and two practical anatomy exams. During the practical exams we are asked to identify various structures (and sometimes their function or surroundings) that have been marked on the bodies of our generous donors. Interestingly, none of the information over which we are being tested is particularly difficult. The challenge remains the volume of information.

Despite all, I'm having a marvelous time. I relish not only my current experiences but also the hope that, one day in the not-so-distant-future, I will be able to do a great deal of good for my patients.

Just for fun, below is our class picture. Believe it or not, I am in there. A virtual gold star to anyone who can find me!

Until next time, God bless you, dear reader. For me, it's back to the books.

So It Begins......

Today marks the end of the first 2 weeks of medical school. Now, technically, we've only had "one" week of schooling, as the first week, orientation, was counted as "zero week" (It sure didn't feel like a "zero week" to me). Regardless, so much has happened....

From what I'm told through the Class Rumor Mill (CRM for short - a VERY formidable force in medical school) we began on July 29th with 264 students. By the end of the first week (again that ignominious "zero week") we were already down to 258. Apparently, after a week of orientation, six folks already decided that this was not for them. 

A few days into "zero week" (I mean, seriously, who does that?) we had already begun our formal studies into MGA (Mean Gross Anatomy and, yes, it can be very gross) to include working on our donors. A quick note about these amazing men and women who have dedicated their bodies for our learning: God bless them. In the couple of short weeks we've been working with them, they have taught us so much, not merely about the human body, but about humanity. I wish there was some way I could thank them. I will do my best to be express my gratitude by honoring their memory by becoming the best physician I can be.

Already, only two weeks in, the amount of material we are being given to digest defies comprehension. This week alone we will be digesting more Mean Gross Anatomy (MGA), Foundations of Modern Health Care (FMHC), Molecular Fundamentals of Medicine (MFM), Essentials of Patient Care (EPC), and Osteopathic Principles and Practices (OPP). We spend all morning (8:00 am - noon) in the lecture hall and most of the afternoon (1:00 pm to 4:00pm or 5:00pm ish) in labs. 

So, what's a typical day like? Its different for everyone but for me, I get about six hours of sleep a night, awakening early. My lovely wife and I have coffee together, I leave for school at 7:30am to arrive to class early. After morning classes I change for lab (usually wear scrubs to most of the labs) and make it home about 5:00pm. I study until it's time to eat, the family and I have supper, the kids are put to bed about 8:00pm and I spend the next four hours or so studying.  I go to bed around midnight or 1:00am. The next day rinse and repeat. Fortunately there is no class on Sunday, so I have all day to study (a good 10-12 hours). 

Today we had our first day of testing, being measured over MGA both in written and practical forms. Yes, I was nervous, but I think I passed. We should get the results by Thursday.

I guess I'll leave you, dear reader, with this: I love medical school. Lincoln Memorial University Debusk College of Osteopathic Medicine (LMU-DCOM: say that fast 10 times....) is an amazing place. Already I've met incredible people, both in my colleagues and in the faculty and staff at the school. Every place has its ups and downs certainly, but this is a special place. Who gets to become a doctor nestled in the bosom of the Appalachians of Eastern Tennessee? I am so grateful to God who brought me here and to my family who is supporting me. I look forward to what the future holds.

Now....back to the books......