Sunday, August 23, 2009

My First Patient

“Doctor, I can’t breathe!”

I stared at our patient: his heaving chest, cerulean eyes, and his pink plastic hair locks. I could hear his eyelids open and close with a loud “click!” His face permanently assumed an expression of astonishment. His soft plastic skin felt disturbingly real. I grabbed his arm and felt his throbbing racing pulse. I looked over to the monitor where I could read his heart rate, blood pressure, oxygen saturation, and body temperature. I leaned closer and stared at his face intensely, as if this was going to rescue him from peril. The room was electric!

“Is it okay if I put an oxygen mask over your face?” my teammate asked gingerly.

“I guess so…”

I was, of course, in a simulation lab. Our patient was a mannequin – a young male with a perfect athletic body, currently posing as a seventeen year-old female with an asthma attack. While simulators like this one can be found in many medical schools around the country, Harvard integrates simulator training into their curriculum starting as early as first year. It was my first ever interaction with a patient.

It was an amazing and novel experience for me. I really liked working with my teammates. We scrambled together to come up with possible solutions for our patient. We asked questions about our patient’s history, their medications, their allergies and whatever else we could think to ask but in no particular order. For instance, we completely forgot to ask their name! Being in a simulated Harvard Emergency room, we could request to perform any test and administer any medication.

“My chest really hurts! It’s hard to breathe!”

“Give us an albuterol inhaler, please!” we asked.

My teammate sprayed two clicks of albuterol into our patient’s wide-open mouth. We looked over at the vital signs on the screen, waiting for a change. And there it was: oxygen saturation went up, signifying to us that our actions helped the patient. We smiled at each other, but our mannequin still complained.

“My chest really hurts!”

My happy feeling was gone. “What’s wrong with her heart rate? Why is it so high?” I wondered. I was really hoping for her to be happy and relieved. We ordered a chest X-ray. It came up on a huge flat screen, looking very pretty in high-res. I was staring at it, hoping to see the solution to this poor young woman’s problem. “Why does her chest hurt? What can I do for her?” I felt so bad. It felt so amazingly real! My heart was racing.

We found nothing obvious on the X-ray, but the consensus was reached that this woman was having an asthma attack. What to do now? We brainstormed a list of medications, but none of us was certain enough of how they were supposed to be administered.

“Let’s call her primary care physician” somebody suggested.

“Yes, let’s do that.”

“What’s their name?” We all looked at each other, puzzled by this basic piece of information.

It was our good fortune that we were able to obtain the name from our patient. We got her primary care physician on the phone and asked about her asthma history. We were told that she keeps it in check pretty well with steroids.

“Ah, steroids! Yes, let’s give her some steroids!”

The steroids brought our patient the desired relief. We successfully admitted her into the hospital and the case was over. Our instructor came out from behind the curtain, smiling. She was incredibly supportive, and discussed the case with us in great detail. She reviewed our performance and made suggestions how we could improve. We were supposed to notice that our patient’s chest was overinflated on the X-ray, but none of us noticed that. The white specs in the center of the film that I thought could have been some foreign body or dust were in fact normal blood vessels and airways. Her heart rate was elevated due to albuterol which we administered early on. It all finally made sense!

I was mentally drained, but thought the whole experience was incredible. My meager performance gave me a boost of enthusiasm, actually. I wanted to go to the library immediately to learn about asthma and the treatments for it. Next time I will know what to do!

On my way home I was reflecting on the events of the day. Absentmindedly I looked around the train car. It was crowded with people returning from work; wary faces, reading newspapers, listening to iPods, swaying to the rhythm of the train. “What if all of them suddenly had an asthma attack,” I suddenly thought with penetrating terror. I turned my head and saw a pregnant woman standing by the door. “What if she had an asthma attack? What on Earth would I do if that happened?”

But the sim lab did not give me lasting nightmares. Rather I had a new awareness that emergencies do happen and that I need to learn to be ready for them. It motivated me.

Monday, August 17, 2009

My First Day As a Harvard Medical School Student

08/17/2009

Fist Day

This morning I had a number of introductions, most notably by Dr. Nancy Oriol – the Dean of Students at HMS. She has a wonderfully charming personality and generously shared her advice about what’s in store for us. “If you’re a male”, she said, “Being a Harvard Medical School student is an aphrodisiac. Showing up at the bar and informing men in there that you’re a medical student at Harvard is death for a female”.

We shared our excitement and worries with each other (just a few hours earlier a lengthy session on mental health hazards and treatment was conducted). On a large blackboard Dr. Katharine Treadway, our instructor for Introduction to Profession class, neatly listed our points of excitement. Her writings were encoded in a language that I might one day be able to read and understand comfortably. She used single letter abbreviations for “with” (looked like marriage of e and a coma) and “without” (an s with a bar?) which I have never seen in my life. Also “b” for “be?” and other symbols. Her “E” looks like a dollar sign missing one bar.

Among things people were excited about:

- Being somebody’s hero

- Becoming an agent of social change

- Being a Harvard student

- Reaching catharsis when it all begins to make sense

- Classmates

Solid, positive stuff. Upbeat. Then we started filling out another half of the board with our worries and concerns. Things like DEATH and DEBT appeared in caps and the mood changed.

- Harming people inadvertently

- Disappointing myself and my community

- Cynicism

- Workload

- Classmates

Interestingly, “Classmates” appeared as both, an excitement point and something to worry about. One student’s exhilaration “My classmates are all geniuses and very incredible people!” became another’s fear “Are they all going to be like geniuses and all, how am I ever going to make it here?” Yet another student wondered – anonymously – if adcom has made a mistake with their decision to let them in. Yes, we were all worried and anxious, but still excitement prevailed.

After getting my ID, I walked up to the main entrance to the Gordon Hall building. Its heavy doors seemed impassable. I remembered the day I came to interview. I thought these doors would never open for me (there was also a helpful sign that said “No Access Without ID” here). So now I held in my hand the magic laminated key to these doors. I swiped the card. The yellow light flickered but remained unaltered. “Hem-hem,” I thought, “Perhaps I’m not all the way a student yet? This does say a temp ID…” But that moment I looked over at my new friend and my confidence returned. This is my first day as a medical student at Harvard. I met amazing people today. I received a heartfelt welcome from so many distinguished students and faculty. I have a new mailbox and a new home, my society home. With a confident “SWOOSH!” I swiped the card again. This time the light turned green and the door clicked, and Harvard Medical School door opened and let me in.

Tuesday, August 11, 2009

Interviewing at Dartmouth Medical School

I interviewed at Dartmouth in the fall. The day was October 16th. I took the Dartmouth Coach bus from downtown Boston where I live to Hanover, NH. I got off the bus on a drizzly afternoon to find myself in the middle of a quaint rural neighborhood which was clearly NOT Dartmouth… There was not a sign to indicate where I was nor was I anywhere near my presumed hotel location. I walked into a different hotel lobby and asked how to get to Dartmouth. I was told I have to take a $60 cab ride to White River Junction, VT -- so much for cheap travel to NH -- but hey, at least I knew where I was! Finding a cab in New Hampshire is not possible. In Boston there are frequent cab stands, but in New Hampshire if you want a cab you have to call in and wait. It took another hour of plowing through rush hour traffic to get to White River Junction. My hotel was a shabby brick building in the middle of a parking lot, but there was a big Wendy’s banner in the middle of it -- so I was happy. You can never be too far from civilization if there’s Wendy’s!

Next morning I had to take a cab to the admissions building, but this time it was only $15. I was greeted by the most incredible, friendly admissions staff! Interviewees were shown into a large antique room with high ceilings and bay windows. We all had a chance to hang out and chat, and have coffee. The official part started at 9am. We met with the dean, and the financial aid director. All struck me as the friendliest people. The atmosphere was incredibly casual and relaxed. Both of my interviews were at the Dartmouth-Hitchcock Medical Center (DHMC) and both were with medical faculty. To get to DHMC I had to take a free campus shuttle. It took roughly 30 minutes to get to the complex. A student-guided tour was offered, and a lunch at the hospital cafeteria (it really was not bad). To get back to the admissions building was trickier. A number of shuttle buses run from the DHMC and only one takes you back to school. I had to wait for that one for 45 minutes in the rain. I left Dartmouth around 4pm that day on the bus back to Boston. Overall I had the most positive impression of the school!

What did I like about Dartmouth?
I was most impressed by the atmosphere inside the Dartmouth-Hitchcock Medical Center. It’s a brand new construction and is rather enormous, but inside is designed like a shopping mall. They told us the architect designed the building in a way that would feel friendly and familiar to patients, and I really think they did it right. In the middle of the main hall there was a big concert piano. Doctors would come over and play calming music on it all day long.

I read New England Journal of Medicine and I frequently see articles on public health published by MDs and MD/PhDs from Dartmouth. The school offers a variety of research opportunities to its students in both clinical and basic sciences. There are lots of funding options available to graduate students, although I could not find a similar comprehensive resource for medical students.

Dartmouth-Hitchcock Medical Center serves New Hampshire, Vermont and parts of Maine. Students have the opportunity to see cases from all three states. Dartmouth is the only medical school of this strength and size in the area, so most difficult cases go to DHMC. When I was waiting for a bus to get back to the admissions office I met a young man with a huge surgical scar on his forehead. He was injured by a bomb in Iraq and was treated at DHMC for injury-related epilepsy.

After I was accepted I received the most personal treatment from the financial aid office. They were helpful, responsive, and very efficient. It was easy to reach a person and get help with filling out forms and supporting documentation. Dartmouth offers generous financial aid and no-interest student loans.

What did I not like about Dartmouth?
The medical center is quite far from the school and even further from residential areas. While free shuttle service is available, it is not efficient enough for a fast-paced life style of a medical student. You really do need to have a car.

New Hampshire is a very rural area – it’s only two hours away from Boston, but it is much less densely populated. You have to drive everywhere to get to a supermarket, go out for dinner, movies, and get coffee in the morning. On the other hand, it’s at the heart of traditional New England recreational activities like hiking, skiing, and snowboarding. In the fall it looks gorgeous.

I was concerned about the conservativism of DMS curriculum. It is heavily lecture-based with little research focus and problem-based learning. While certain aspects of it were attractive – community-based patient interaction programs, mentoring programs – it was not the best fit for my research interests in medicine.

Fun facts about Dartmouth
Dartmouth is a historic place. It was the fourth medical school in the US – way before John’s Hopkins was built as a large medical school. William Osler, Harvey Cushing, and other huge names in medicine all came here to give lectures and seminars.
 
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