October 8, 2015 § 3 Comments
Thursday is my one true clinic day of the week. I start with dermatology at 8:00, followed by pulmonology at 12:40 and cardiology at 15:45. Each of the practicals lasts 1.5 hours and there are pulmonology and cardiology lectures before their respective practicals. It’s probably the one day of the week where I feel most like a medical student and yet it’s easy to become sort of numb to it. When we are constantly focusing on how much we have to study when we’re done with class, it’s hard to actually enjoy it while we’re there. The one thing that helps is a good teacher! I love my teachers for pulmo and cardio because they are systematic in their teaching and take the time to describe disease mechanisms in detail, while still highlighting major points. Here’s a breakdown of my day today:
We see up to maybe 5 or 6 patients during the practical. When we first go in to the room, we are expected to describe the skin lesions using correct dermatological terminology and then get the patient history. Once we’ve done that, we are asked if we know the diagnosis. Sometimes it’s really obvious (like psoriasis) and other’s it can be more difficult. One thing I noticed today is that I had a hard time recognizing some things we learned for patho – because I’d never seen then before. I might have looked at a random picture here and there, but when you are studying skin lesions for your patho final, everything looks the same!
- Patient 1: Erythematous patches on bilateral anterior axillary folds, erosions and scales in inguinal region and under gluteal fold. Diagnosis: Scalded Skin Syndrome. It is the result of a staphylococcus infection. It usually occurs in infants, but this patient had a history of diabetes with foot ulcers that may have aided in the establishment of the infection.
- Patient 2: Erythematous macules with erosions and bloody crusts on the trunk and upper and lower extremities. Diagnosis: pemphigous. An autoimmune disease where the antibodies attack a protein in the skin (desmoglein 3, transmembrane glycoprotein in the desmosomes) that is necessary to hold skin cells together. Our teacher suspected that the outbreak of the lesions could be due to internal malignancy and said that they were doing tests to see if this was the case.
- Patient 3: Large brown plaques on lower abdomen and inguinal region (should’ve been firm to the touch, characteristic for this disease, but they weren’t). Diagnosis: morphea/localized scleroderma. A localized thickening of the skin resulting from several different etiologies, e.g. local injury, tick bite (borrelia infection), pregnancy, autoimmune disease.
- Patient 4: Numerous solitary papules with slightly white surface (kind of like candle wax drops) around the wrists and ankles. Diagnosis: lichen planus. An autoimmune disease in which immune cells attack an unidentified protein in the skin.
During this practical we usually see 2 or 3 patients and then follow their cases through all the way, including lab tests and imaging. Today we saw two patients, both with COPD, but very different manifestations. These are my notes from the practical:
I’ve actually missed the past two weeks of this class because I’ve been quite sick (and my nasty cough just won’t leave!). One girl in my group joked to our teacher that he should examine me and he – without hesitation – said that we could do an X-ray. I’ve never had an X-ray of my chest before, so I jumped at the opportunity. At the end of the class, another classmate (curious about his new chest pain) went down with our teacher to check our insurance details at the registration desk and then headed straight for the X-ray room. Within 5 minutes, we were back up in his office looking at our X-rays on the computer. It turns out that my lungs and heart are quite healthy, but he wrote me a prescription for my audibly-obvious bronchitis (not seen on the X-ray). He emailed me my X-ray (have I mentioned how much I love technology) and now I have it to compare to future ones. Pretty cool to see my heart and lungs! I’ve looked at so many others before, I’ve forgotten I have my own.
Here you can see how different the chest x-ray can look:
These practicals vary quite a bit. Sometimes we have special lessons focusing on specific topics and others we examine patients and then discuss their cases afterwards.
Today our focus was heart failure. We met two patients and watched our teacher perform their echocardiograms (an ultrasound of the heart and the gold standard for diagnosing heart failure).
Afterwards, we walked through the gorgeous gardens of the cardiology hospital (probably the nicest of the hospitals we visit) to get to the Phd student lab. Here, our teacher went through heart failure in perfect “this is how you need to know it” form.
I notice such a big difference this year compared to the others. Of course, there are some teachers that are a little extra hard on us, but most of them are excited when we show interest in a subject. On numerous occasions we have been invited to join an operation or a night shift, anything we want. The opportunities are endless so long as we take advantage. It feels so good to know that they are so willing to teach us and that we can take it as far as we want it to go.
Night coughing has started up again and I have to be up early for anatomy TAing. Skjalg’s family arrives tomorrow and I’m excited to do some non-school-related activities these weekend – despite the horrible weather!
October 7, 2015 § Leave a comment
Today is a library day – and I’m loving it! Out of all the semesters, the 2nd semester of 2nd year was my absolute favorite. Why? We had only 22 credits and that meant plenty of time for studying. If I remember correctly, I had almost all of Monday, all of Wednesday and almost all of Friday at the library. Since then, things have been chaos. This semester, I have 36 credits – and that’s low compared to some people! So, today I stole a day for myself and skipped two lectures…
My goal today is 6 Derma topics, 6 Pulmo topics and 5 cardio topics. So far, I’ve done 6 Derma and 1 Pulmo. Here’s to hoping that the rest of the day is equally, if not more, productive! I’m loving and hating my study plan now. Hating it because I have yet to make all my goals for one full day and loving it because it shows me how much work I should be putting into everything. Progress not perfection, right?
Food packed and ready for a day at the library. Food prep for the win!
All by myself….
View during my lunch break. Not bad! Despite the hazy weather.
My day was made when I saw that Notability (the program I use to take notes) has upgraded to include multi-tasking (which makes it so I can use two programs on the same screen on my iPad). I’ve started making flashcards for everything (a prep tip I learned for the USMLE) with a program called Memorang. So far, I’m impressed!
Update – final results of the day: 6 Derma, 6 Pulmo, and 0.5 cardio topics. Faster than I normally am, so I’ll take it!
After watching the sunset (through windows that looked like they’ve never been cleaned) at the library, I met Andrea at a chocolate bar called Noir Chocolate near Oktogon for study session two.
I ordered a salted caramel hot chocolate (when in Rome…) and a mango tea. The hot chocolate was almost like a thick soup – Andrea’s was even at the level of a super moist brownie. If you’re a chocolate lover and can handle some serious dense goodness, this is the place for you!
Cozy atmosphere, chill music and the smell of chocolate made for a tantalizing study experience! I love to study at new places. And it’s even better when they are special little hole-in-the-wall-places and not large chains.
With that, I’m off to memorize my two radiology images for the day (we need to know 40 for the midterm, so I’m learning 2 each night before bed). Long day of practicals – and patients – ahead!
October 5, 2015 § 1 Comment
Four hours spent prepping food for the week has earned me a glass of red wine while I finish up my study tasks for the night. Food prep never feels worth it when you’re actually doing it, which is disappointing. It will be very nice though when I have to spend 0 minutes and 0 money on food this week. I made coconut protein pancakes for breakfast (with enough left over for small meals if need be – or for the hungry boyfriend who goes sneaking for snacks) and 7 portions of chicken breast, green beans and sweet potatoes. Riveting post by this point!
I have two posts that I want to write as soon as I have enough time. The first is pictures and details from my mom’s visit earlier this month and the second is about an amazing day Skjalg and I had last week, one that I’m sure we’ll remember forever. Here’s a little teaser:
My future posts may become shorter and more frequent. With studying for classes, research, TAing, and starting to study for the USMLE (slowly!), I’m realizing that this is going to be another semester like the first semester of 3rd year – heavy and hectic! It really shouldn’t be, since 4th year is infamous for being the “easy, chill year”. Leave it to me to overcomplicate it ;). With so much occupying my mind, it’s not often that I find myself in a reflective mood – and therefore not very often I am inspired to write. But these days do as well hold memories that I will want to look back on later in life. The blog must go on!
This past weekend was spent finally getting into a study groove. On Saturday morning, I met with Andrea for a first ever study session at a local hole-in-the-wall coffee house. It’s never too late to get to know people you’ve “known” for years! We chatted for a short 3 hours and then agreed that it was time to get back to the books. I really admire her study style and didn’t hesitate to ask her how she does it. As we were talking, something clicked and I suddenly felt an extreme motivation to study – something I’ve been chasing since the beginning of the semester.
On Sunday, I made a study plan for the next month and a half or so. It’s quite ambitious, but it gives me an idea of what I should be aiming for each day – and that is important! Plus, it forces me to study for other classes than pharmacology – the big one this year. I’ve picked out days during the week for the various topics and then divided up the topics from the topic list for those days. Wednesdays are impossible – for example, 2 pharma topics, 6 derma topics, 6 pulmo topics and 5 cardio topics planned for this Wednesday alone – but I can use it gauge my progress and efficiency. If I only do 1 topic that whole day, something is wrong and I need to reevaluate my study methods!
Falling short on topics today! Hopefully all the time I saved by doing food prep will pay off later this week. Now, I’m going to finish my wine and review some images for radiology before I call it a night.