On Sacrifice

A few weeks ago in small group, the topic of physician sacrifice surfaced, and from that topic came a proverbial outpouring of emotion, anecdotes, and confusion. What are we, as medical students and later physicians, expected to sacrifice for our patients? Where do we draw the line?

The MD in charge mentioned for the second time this term some advice that an older neonatologist had shared with him over a meal. His only regret was not being there for his family and sharing moments that were pivotal in the upbringing of his children. This got me thinking.

We all mentioned things we had to sacrifice throughout medical school. Time with family, playing musical instruments, hanging out with friends, having relationships. Not going outside on this beautiful St. Patrick's day is a seemingly menial illustration of our sacrifice, but nonetheless representative of the daily struggle of being a full time student.

I for one, miss my family. I have been away from home since I was 17 and started my undergraduate career at Drexel University. I worked the summer post undergrad and went directly into medical school, something that I now think of as a mistake. Here I am, 23 years old, and on the road to being an MD in two short years. All I can think is, where did my youth go? One second I was an energetic, enthusiastic biology major and now I am a slightly burnt out slave to a syllabus. I missed seeing my nephew and niece grow up, and every time I come home they look more and more different than before.

The road ahead is long, but paved with worthwhile moments, I hope. Spring break is 2 days away, but I will spend most of it studying for an exam I had to miss due to a death in the family. At least I will be home. I look forward to laying on the hammock and sunbathing as well as bike rides with my nephew. The simple things city life doesn't afford me!

I would imagine all of my classmates feel a little homesick and lonely come exam time, and I guess that just comes with the territory. It may hurt now but the reward of helping patients for the rest of our lives is an incomparable payoff.

Taking Patients to the Heart

As a future physician, nothing bothers me more than students treating patients like they do textbooks: solely as learning tools. Like the textbook, they take from the patient, probing and reading labs, feeling a momentary shiver of excitement with each possible diagnosis, and continuing to the next chapter when they've learned all that is possible or interesting. Constantly bombarded with "clinical scenarios" describing could-be patients with very real ailments compounds the issue, forcing the real patients to bear the brunt of our insensitivity and social clumsiness. The purely intellectual awe geared towards a patient with a horrible "zebra" of a disease trumps any semblance of empathy towards the pain and suffering being experienced.

Patients are not disease states, they are people with stories to tell and a modesty and dignity that is the physician's responsibilty to maintain if ever they cannot. Yes, future physicians have to learn from the sick in order to treat the sick, but they must also respect and understand them. I have been lucky enough in my lifetime to have never been hospitalized, but if I were a patient I would feel horribly uncomfortable knowing the sometimes locker room-esque antics exhibited behind closed doors (or curtains).

*Photo depicts a human heart with a left ventricular wall aneurysm, a feared sequelae of acute myocardial infarction.

Patient with History of Acute Leukemia Visits, Inspires

Today we had a visit from a very special patient, an individual with a history of Acute Myelogenous Leukemia. Listening to her story definitely helped to put the laundry lists of drugs and diseases we have to know into perspective. The disease and treatment courses are long, painful, and sometimes dismal, but this patient showed a resolve and strength that was truly inspiring.

Put simply (even though nothing is ever simple), leukemias are a group of cancers that arise in the bone marrow. Progenitor cells are damaged and this leads to proliferation of abnormal cells. This leads to a "full" appearance of the bone marrow. Because the bone marrow is stuffed with abnormal cells, synthesis of cells normally made in the bone marrow suffers. A decrease in red blood cells, white cells, and/or platelets may lead to anemia, infection, and impaired clotting, respectively. This is manifested by the disease symptoms of fatigue, shortness of breath, bleeding, bruising, fever, weight loss, bone pain, etc.

Luckily, there are treatment options for leukemia, and in our patients case, it seems as though she has made a full recovery. It is great to see patients before the advent of our clinical years, since I feel this allows us a constant link to reality while we bury ourselves in textbooks. Also, the emotion we link to a patient and their story helps us to remember the details come exam time. The hippocampus is right next to the amygdala, after all.

Photo is a bone marrow aspirate of an individual with Acute Myelogenous Leukemia (AML)

Sale of Thomas Eakins Painting Helps Put MD Hopefuls Through School

The selling of this Thomas Eakins masterpiece, "The Gross Clinic," by Jefferson Medical College led to the creation of many scholarships, designed to put future doctors, like me, through medical school. The Eakins Legacy scholarship fund, of which I am a recipient, helps to alleviate some of the financial stress associated with attaining a medical degree.

The Eakins painting depicts Dr. Samuel Gross, the father of modern anatomy, lecturing a group of Jefferson Medical College students. Eakins is depicted over Gross' right shoulder, making a sketch.

A replica of the painting hangs in the beautiful Eakins lounge in the Jefferson Alumni Hall on 10th and Locust Sts, Philadelphia.

Thanks Mr. Eakins!

New beginnings, at the risk of sounding cliche.

So, I decided to change up my blog a little bit, mostly because no one was reading it but also because I am feeling a bit more optimistic about the whole medical school business. Second year is winding down and pretty soon I will be taking the boards. I am starting to feel some serious pressure with the material we are working on. About two and a half weeks to go through hematology and dermatology, with the latter being crammed into 3 days the beginning of exam week. Oh joy, oh rapture! I have been learning most things from Wikipedia (warning my future patients) because for some reason I feel like MDs are incapable of wording ANYTHING concisely. Jeez, Louise!





I also discovered the wonderful world of Goljan a few days ago. I listened to 15 minutes of one of his hematology lectures and actually learned and understood what I have been reading for days. He is funny too! I mean, not funnier than, say, Dr. Mangione, but he is pretty funny. I can appreciate his stabs at humor...ohhh that was a hematology joke! (rim shot)

*Picture shows an acute splenic infarct from a patient with sickle cell anemia. These patients are at risk for autosplenectomy as a result of numerous bouts of splenic infarct and hypoxia.

Knock You Down

Awkward Moments Part Deux

Part Deux!