Monthly Archives: November 2013

Rookie mistakes

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Editor’s note: I sutured my first patient two days after this post. You never know when you’ll get your first opportunity to practice new skills!

Forceps in my left hand, needle driver in my right hand, the feel of the metal in my gloved hands– I am ready to sew. “Can I tell you a secret,” I hear a whisper over my shoulder from the instructor. “If I was going to tweeze my eyebrows I would hold the forceps like you are, but what we are trying to do here is sew a wound…” My face turns bright red. Apparently all those times I shaped my own eyebrows are not coming in handy here. Even holding tweezers is different in medicine. Tweezers are called forceps and are to be held like a pencil. A needle driver looks like scissors, except it locks tightly onto an object (your needle) and you maneuver the lock with the action of your wrist and fingers.  Everything I am about to learn feels completely foreign to me. Was this what it felt like when I was in kindergarten and tried to cut a straight line for the first time?  My hands feel clumsy and awkward as I maneuver my new tools. We are practicing on pigs feet, which resemble human flesh to an eerie degree (personally I would have preferred an eggplant). In the end, my wound closure is not awful. I did a passable job on the simple interrupted suture and a fairly decent running stitch. With practice, this too will become as second nature as typing–right?

The instructor tells us the suturing mistakes we absolutely-cannot-under-any-circumstances make when we are on our OR rotation, or the residents will have our heads and worse we will have a leaky wound closure and endanger the patient. It sinks in that I will be expected to perform these techniques– and sooner than I think. I imagine the horror of having a surgical incision open after the attending lets me close. I feel like practicing  1,00o stitches before I go home.

Wound suture is just one of several new techniques I have tried to master in the past few weeks. No beginners luck here. My first intubation resulted in pumping my dummy’s stomach full of air. My first epidural leaked spinal fluid (also done on a dummy thank goodness!).  I am not afraid to admit my rookie mistakes. With each mistake I am learning what to avoid and how to tell when my technique is correct. It is exhilarating to try all the procedures I’ve only ever seen done on TV.  I have a lot to learn but I am grateful for the opportunity to start learning now, with plenty of time to get comfortable before anyone expects me to have these skills.

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The First Cut

For the past couple of months my blog has fallen into radio silence. After 9 exams in 7 weeks I am back to recount the experience. Medical school continues to be a fine line between fascinating and at times unbearable. It pushes you to the brink of insanity, only to revive you with moments of awe and admiration for the complexity of the human body.

I now understand why getting into medical school is so difficult, the rigorous amount of studying that is expected of you is not for everyone. Over dinner last night, one of my classmates was counseling a colleague and she advised him that “you don’t want to date a doctor, we’re all damaged.” I think she was right, there must be something wrong with anyone who willingly wants to put themselves through this. And to think, this is just the beginning…

The past seven weeks have left me in a constant state of low level anxiety. You know that anxious, excited, slightly nervous feeling you get when you have a final exam coming up– now imagine having that feeling every week because the exams just keep coming. The seven weeks of exam hell culminated in the mother of all exams– my first anatomy practical.

I knew going into medical school that gross anatomy was going to be part of the training. On the surface, I may have even been looking forward to it. But as the course loomed closer, I was surprised how difficult I found the idea of that first cut. For several days before our first dissection I became increasingly uneasy with the idea. I was about to embark on a very special privilege and the gravity of that privilege was sinking in. If this was any other setting, cutting into the deceased would be a federal crime. Yet someone had donated their body for the purpose of my instruction. I felt immeasurable gratitude to them. I also felt a stronger connection to the medical profession and the duties bestowed on me as a result.

After you get over the initial smell (the smell that never really leaves you), the strangeness of cutting into flesh, and the fact that this was once a living, breathing, thinking person, anatomy becomes fascinating. The human body is fascinating. Being able to see the intricate inner workings of the human body is fascinating. Getting through a gross anatomy course is difficult for many reasons–it is difficult emotionally, intellectually and even psychologically. But in the end it provides you with a type of training that is incomparable to anything else.

An anatomy practical is unlike any exam I have ever taken. Lasting about 3.5 hours it consists of a written multiple choice exam and the actual practical, which is a set of 50 stations set up throughout the anatomy lab. The instructors pin various structures and you have 1 min and 30 seconds to answer questions related to that anatomical structure before moving on to the next station. The structures could be anything from the thoracic duct (lymphatics), a coronary heart vessel, spinal nerve, to specific muscle. What is pinned corresponds to the dissections we’ve done up to that point. The questions typically revolve around function, innervation, or a clinical correlate–such as, the pin is located on a coronary artery, if this is is occluded this is the (blank) most common occlusion for a myocardial infarct (heart attack).

Studying for an anatomy exam pretty much takes over your life due to the sheer amount of material that is presented and expected to be memorized for the exam. Imagine having to know every single word of a 60 slide power point and that is just 1 of 8 presentations. It is intense, but fun. I think the entire week leading up the exam all of my dreams revolved around vertebral levels and neurovasculature.

The Course of Their Lives is a wonderfully written 4-part article on the experience of taking gross anatomy. If anyone is interested in going to medical school or has friends/family going through the process, I highly encourage you to take a look:

http://www.jsonline.com/news/health/The-Course-of-Their-Lives-Medical-College-of-Wisconsin-students-gross-anatomy-class-225058322.html#!/the-first-cut/

The next few weeks will be more laid back (no exams and a break from anatomy) yet just as fascinating as we learn about reading and interpreting EKGs, intricate details of cardiac function and the immune system and acquire additional training on ultrasound. Let the adventure continue…

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