It was in the afternoon. I'd been volunteering for about two months at this point and had seen all the "basic" calls - diabetic with low blood sugar, shortness of breath, transfers to hospice, chest pains, etc. It was another shortness of breath call and I remember thinking "Another one? When am I going to get to see something good?"

I'm aware that wanting something interesting to happen makes me morbid and inconsiderate. But in my mind, "something interesting" happens all the time anyways, I just wanted to be there when it did.

It was still sunny when we arrived. He had his shirt open, exposing his chest, and looked "sick". Or apparently looked sick, because I didn't notice, and it was only because the medic noticed and later talked about it that I can relate that. Seventeen years on the job will give you those sorts of instincts... I hope to someday have them too.

He only said he couldn't breathe, and then his spouse took over. He'd had recent surgery. She had been at the store and came home to find him complaining of having trouble breathing, so she called us. He passed out almost instantly, and we moved him to the floor. The medic and the other EMT started assisting his respiration. I took over bagging while they did other things.

The medic was trying to intubate and asked for "cricoid"... the other EMT was confused, maybe he didn't hear her correctly. We talked about that two weeks prior in my human physiology class, so I placed two fingers over where I imagined his thyroid was. Later the medic told me she was impressed that someone who'd never been on an arrest call knew what to do. It made me glad I study.

Another medic showed up to provide "Advanced Life Support Backup" (ALS Backup, so they say.) He started an IV. Fluids were pushed. I felt nothing while this was occurring. I was too busy counting to 8 and squeezing the Bag-Valve-Mask (BVM). He was packed up into a Reeves stretcher, and moved to the actual stretcher waiting outside. Somewhere between the house and the rig, he lost his pulse. The medic started chest compressions while everyone else strapped things down and got ready to move.

At some point during the ride, I took over compressions. I still felt nothing, but couldn't stop counting to eight. Just a continuous 8-8-8-8-8, this time with no punctuations of squeezing a bag. His eyes were open, seeing nothing. Emesis was coming out of his mouth, on the outside of the ventilation tube. I did compressions until I needed a break. The other medic took over.

We arrived at the hospital. It could have taken five minutes or an hour, I was unable to account for the passage of time. The medic directed me up onto the rails of the stretcher to continue compressions while we wheeled him into the ER. Later I was informed this was the "glory spot" and was called "riding the rails."

Report was given at bedside. I removed my gloves and washed my hands. I stood in the room and watched the nurses, doctors, and other professionals take over. I became aware of beads of sweat running down my abdomen, inside my uniform shirt. I was not shaken, did not have the jitters, and was not consciously aware of any adrenaline rush. But I could hear, see, and smell everything. I was focused on the task at hand. I felt no emotion.

They recovered his heartbeat at the hospital. We cleaned the rig. While I cannot guarantee how long his heart continued to beat, it was beating when we left. I do not know if he woke up. I don't know what happened next. I know only that I crossed the line that afternoon, from the group of people who've learned CPR and never used it, and into the group of people that have.

I felt unsettled the next morning. Not unhappy. Just unsettled. I couldn't get a grip on how I felt about the experience until several days later.

I feel good. I feel like I was a taught a skill and then trusted enough to be placed into a situation where I needed to use it. The classroom did not prepare me adequately, but does it ever? I got an "A" in my class, and had the top score for the state test. It was not a lack of preparation, but simply that nothing can prepare you for that experience.

I hope to be better prepared next time. I hope to provide better assistance. I need to learn where the leads go for the monitor, and how to set up the capnography apparatus. I don't want to let this whole thing go without examining it and trying to figure out what I need to learn.

What I learned most of all is that I can respond appropriately in an emergency and that my adrenaline rush comes in the form of increased focus and a methodical approach. The world for me slows down, and I with it. I learned... that I chose well for my future profession. That I want to be here, dealing with these issues, and that when I get there, I'll be completely unprepared but totally willing to learn.

(details have been changed in order to mask identity)

My primers worked! My PCR scheme worked! My gel worked! It was an awesome day in the land of research. Last semester I was doing a genotypic identification project on the 800+ strains of yeast that the lab uses... this semester I'm doing a protein-protein interaction study with yeast-2 hybrids. It's funny how things accelerate quickly once you know some basics, no?

Anyways, the lab is awesome. I came in just as things were getting started and rounded out the lab "staff" to 3.5 (there was a guy who only did summers, the PI, and the lab tech when I first started). Now we're up to 6.5 and have a bona fide "media preparer" working the lab. It's an exciting place to be, and it's fun work. The PI is on the younger side and is wonderful to work with, always explaining things, making jokes, and making sure we understand.

I didn't know research would be fun. I started out looking for research because "you're supposed to do research" and was quite honestly intimidated by it. Now that I'm actually doing it with some success, I can't believe I didn't start sooner. There are lots of people "volunteering" in the research lab who not only get to park for free and earn a free meal when they put in more than four hours, but they get to learn all kinds of interesting research skills. How are more people not doing this?

Oh that's right... not everyone is nearly as interested in this stuff as I am. Anyways. This Friday there's a research symposium at my university - an undergraduate event put on by undergraduate researchers FOR undergraduate research hopefuls. It's supposed to provide an opportunity for people to ask questions, talk about their research, and help other people get into the lab. In that vein, I guess I'm here talking about it in order to encourage other people who may not have figured out "the research thing" to jump in and give it a shot.

So, who else is doing research, and what are you doing?

(PS - Thank you Dr Fizzy for the shout out! And WELCOME! to my new followers who came here via her blog.)

Humanism in Medicine (Probably just part one)

I started my "post-decision" volunteering by volunteering in an ER. It was a small, local hospital in the suburbs and for the most part, I felt like I was in the way. I was only there for about two months before I had to take a leave of absence for classes, but the experience was such that I did not elect to go back.

Instead, I decided to become a certified EMT and volunteer with a local ambulance service. This experience has been much more productive, I don't feel like I'm in the way, and I'm learning a ton of stuff. In fact, I generally can't wait until EMS-day and wish I could find a way to fit it in more than once a week.

Much as I really enjoy my volunteer experience, I had a call the other day that really drove home a significant point for me. I've literally spent years watching medical dramas, reading med-student books, blogs, etc, and I've always thought the same thing... "Gee, some of them really dehumanize their patients and catalogue them as nothing more than procedures... that's totally not going to happen to me!"

Well. It did. It's hard not to get caught up in the moment. It's extremely difficult not to get excited that I got to perform such and such a procedure for the first time. And the capstone on all of that is that it's even harder to remember that this is someone's father, mother, grandmother, sister, loved one... that is going through a very scary medical crisis.

I know that I cannot allow every single patient experience to affect me so profoundly or access my emotional bank... but I'm going to have to find a way to keep the human aspect within sight. I also understand that learning procedures today will help me become a better clinician, will help me save people down the line, and will ultimately be good for me and everyone I come in contact with... but that doesn't mean that I have to reduce people down to an intubation, or a successful blood pressure check.

This experience is uniquely mine, but it is not mine uniquely. I imagine the vast majority of clinicians ahead of me (and those who will come after) have struggled with this issue and found a way to muddle through. I'm going to have to do the same thing.

I am nearly ashamed to admit that I didn't think this would be an issue for me. I honestly thought that because I was thoughtfully considering the human aspect of medicine that I wouldn't have to have this little heart-to-heart with myself. Turns out this was just one more thing I was going to have to experience before I'd truly know how I'd react.

Shadowing

So, this may come as a bit of a surprise to some people, but I can be a bit shy from time to time. Not, say, in everyday life or in normal circumstances that plague regular people, no. But in unfamiliar situations, well then yes.

Case in point: shadowing. I need/want to shadow some doctors. I'm not even picky, and I kind of want to shadow all different kinds. I work in a hospital that is chock full of doctors. This seems like it would be easy. Walk up to doctor, say 'hey, can I shadow you?', he says yes, boom, done.

But it isn't that easy for me. I mean, is that what you actually do? Is there a form that needs filled out? How do I get him to see me as a real person and not a stretcher-monkey? What if he says no? That's generally my biggest concern. If he says no then I will be embarassed every time I see him and will feel silly having asked.

Do doctors like having med school hopefulls following them around? Or is it annoying? I just don't know. So here we are. I'm swimming around in a sea full of the resource I need, but scared to take a sip.

Today I'm meeting with my med student mentor, so hopefully she has some insight into the process and maybe, just maybe, a little bit of what I like to call "the hookup". I mean, it couldn't hurt, right?

Everest is a big mountain...

So, while I was project managing, one of my favorite stories was how when you climb everest, you have to keep going down, then going back up, then going back down again, in order to acclimate yourself to the lower atmospheric pressure (and thus lower O2 pressure). It was basically a story about how getting there sometimes requires going in the opposite direction.

So anyways...here we are in the "new" version of my life and I find the same to be true. Over the summer I learned that we shouldn't over-schedule ourselves if we want to be successful. Now I'm learning that if you didn't get everything you needed in "First Semester of Subject" you won't actually understand anything in "Second Semester of Subject".

This seems like a no-brainer, right? The only problem being that my first degree, while progressive, did not have a linear progression to it. If I didn't like Practices in Human Resources, I only had to suffer for fifteen weeks, memorize enough to pass, and then it was over. With science, if you don't understand acid/base chemistry, there is no escape. It will keep coming up again and again over and over until you just hunker down and actually learn the differences between pKa, K, and pH.

So. What does all this mean? It means getting a "C" in Organic Chemistry I is not enough to prosper in Organic Chemistry II. So here I am again, in OChem I...

...and yes, I feel a bit "fail-y". But I also learned that true failure isn't retracing your steps, but in ceasing the journey altogether. And quite frankly, I'm not giving up. I'm trying again, this time with more focus.

Besides, this gives me a great way to segue into examples of my perseverance and show proof that I don't give up. I'm shooting for an A+ because I think it makes the point all the more poignant.

(And looks good. Let's not ignore the fact that I'm a weaselly pre-med student...)

(By the way, if you are also pre-med, or post-med, or interested in the life of the med student, or medicine, or hey, just happen to like funny things, cruise on over to this blog.

and check out the funny cartoons. And then, if you really like 'em, you can get them in book form!)

Yay Doctor Fizzy! :)

New Year...

We're closing in on the last day of the year, a situation which tends to make me reflective. It's been quite a year, 2011. This was the year that I started putting dreams to action, the year that things started to gel together and form a path forward. October 14, 2010 was the day I decided to go to med school. 2011 was the year it started to happen.

I started the year with a brand new plan, a chemistry and biology book, and a lot of hope. I learned early on that science was going to take more than what I'd always done. I studied, I cried, I lamented that I was supposed to be one of the smart kids. I memorized constants and equations. I bit off more than I could chew. I passed organic chemistry.

I tried volunteering in a hospital emergency room. The suburban campus was a bit too slow for me, and I felt like I was always in the way. So I tried a new approach and signed up for an EMT class.

I tried using my network of contacts and informants to secure a research position, but eventually just tossed my hat in the ring for someone looking for a "highly motivated undergrad" who decided I was the one.

I killed millions of yeast. I became so good at PCR that my PI decided I would be carrying out her PCR reactions from now on. I applied for my first NIH grant. I realized there are a lot of hoops to jump through, t's to cross, and i's to dot. The struggle continues on that one.

I fell in love with quiet little moments stolen between study sessions. I realized focus was more important than doing a thousand things at once. I withdrew from my first course - calculus - and realized that just redoubling my efforts was not always the way to succeed. Sometimes you had to go back down to base camp and try another ascent.

I rejoined the workforce in an entry-level position in a hospital. I fell in love with patient contact, and realized the power I had in just holding someone's hand. I worked on small talk, something at which I've never been very good. The weather, where are you from, what do you do, how about them 'stillers, all became di rigeur. The struggle continues still.

I came to appreciate people I had taken for granted. I fell in love with my husband again. My quirky little professor who brought me coffee while I toiled, who cheered me on from the side lines, who told me that yes, I could, even when I didn't think so. Who let me take his vital signs a bazillion times until I finally got the blood pressure thing.

I was more frustrated than I can ever recall being. Chemistry books became my constant companion, and people rarely saw my face outside of them. But even with this, I did not study enough. I did not commit enough time, and I did not do enough problems. So, for 2012, I resolve to study in a different way. I'm trying some new tactics, recording lectures, transcribing notes, focusing more, doing more problems. Less relaxation and tv, more actual work.

2011 was the year where I turned my life 180 degrees and committed all my actions towards one goal. 2012 will be the year where we move, full speed ahead, toward that distant horizon.

And all I can be right now is just thankful. Thankful that I'm here. Thankful that I get this chance. Thankful that I have this opportunity. Thankful for all those people who support me, who keep me going, who read my frantic texts about equations, who laugh with me, cry with me, mix chemicals and distill things with me, and let me borrow their notes.

Thank You.

The joy for me is in the journey AND the eventual destination. So thank you for all those people with me along the way, and for those people who believe I'll eventually get there. You all mean the world to me, and I could not possibly be doing this without you.

Happy new year!

the dream

Passed my EMT practical exam, and in a few short hours, will pass the written. It's like throwing gasoline on a fire... exposure to medicine enhances my desire to practice it. The art of the patient history exam is like playing detective and problem solver all in one.

I've been working at the hospital now for a little over a month. I just work weekends, and while I come home exhausted, I often find myself looking forward to going to work. I even love the smell of the hand soap. I feel like a dry sponge, looking to soak up everything I possibly can, learn everything thrown my way, and talk to everyone who'll talk to me.

I still need to figure out shadowing. It's intimidating, trying to conjure up the cahones to talk to a doctor and ask. Who do I ask? What do I say? How does it work? The thing is, I really want to do it. I want to see what it's like. I want to spend a day shadowing as many different kinds of doctors as I possibly can. If there's something to be seen about medicine, I want to see it.

It's become an obsession, really. I wish I could say the same about organic chemistry. ;)