Experience

Last night I learned how to suture on a pig’s foot. Surprising to me was that there is no great magic secret to it. It’s just like sewing except the needle is attached to the string. We learned four types of sutures and played with the stapler (which is good for shallow scalp lacerations). The best part was when the Emergency doc overseeing all of this told us to come and practice in his ER. I can just imagine the look of horror on my own face if someone with my level of “experience” tried stitch me up. I think the first time I do it on a patient I’m going to have to control my face and try not to look too freaked out. The last thing anyone wants to hear is “oops.”

I heard an interesting story while suturing that kind of goes along with that sentiment. The Stout Street Clinic here in Denver is run by students on Saturdays (though supervised by a doctor) for homeless people. A pair of fellow students had a patient come in for STD testing last weekend. As part of the interview process and getting a patient’s history, we’re supposed to ask about what the patient thinks about their illness or condition or tests being done, and so the students asked this giant bear of a guy why he thought he needed an STD test. The patient said that he had just gotten out of prison and had had unprotected sex. One of the students knelt between the patient’s knees to swab the guy’s urethra, and as the student was negotiating in his mind how exactly to do that, the patient asked, “You’ve done this before, right?” [Imagine their faces] According to my second-hand source, the student just said ‘yeah’ and took the sample.

Second test over with!!! One more to go (hopefully not followed by having to get carried home), and then I’ll be done with the human body block (i.e. anatomy).

Colorado Medical Society annual meeting

YAY Jackson Atlas Leach was born September 12^th, 2007 weighing 6lbs 12 ounces!!!!

Directly from dissection class, several of my classmates and I drove to Steamboat Springs for the Colorado Medical Society’s annual meeting. After three hours and most of the last hour spent discussing the highlights of European food, we arrived just in time for an amazing dinner at Mambo Italiano. The next morning, Governor Bill Ritter kicked off the conference by giving a little speech about health care in the state and nation. Since Colorado has the opportunity to lead the way in health care reform with the 208 Commission*, Ritter just emphasized the importance of cost, quality, and access. I was really amazed by how genuine and well-informed he seemed, and at the same time, he was in touch with the reality of the strangle-hold TABOR has on the state’s spending (power). Maybe not all politicians are the slime they seem to be on tv.

All the rest of the day, we (the Medical Student Component) attended presentations and discussions of the current medical situation and political climate. Lots of it was over my head, arm-waving legal mumbo-jumbo, but every once in a while I got a glimpse of a bunch of people who were concerned with the health care their patients (or future patients) were going to receive.

The next day, we voted on resolutions that were submitted by members. The Medical Student Component submitted a resolution to have health care recognized as a human right, with the hope that when you start talking about health care in terms of human rights, access for all people gets dragged into an ethical arena, rather than just a financial one. I heard an interesting counter-argument to the idea, stating ‘how could something be a right if it has to be provided for you’. However, if you think about what we call human rights, many of them already fall under that category- education (being the best example) and social security (taking care of old people, not the American check sense) just to name a few. Health care is already recognized as a human right by the United Nations Universal Declaration of Human Rights* article 25.

Long story short, the CMS lawyers thought that calling it a right created the potential for legal ramifications, i.e. lawsuits, so they voted the resolution down. We countered with an amended resolution stating that health care was a “fundamental societal obligation”, which basically says the same thing, but spreads the blame over all society for its failure to provide. In its new language, the resolution was unanimously adopted.

In my opinion, people are the same as animals, and I don’t think we have any special rights just because we’re capable of higher brain functioning. I do, however, think that “human rights” are a statement by our society about the kind of world we want to live in. When you look at it from that perspective, a lot of other concerns lose priority- price tags, profit margins, ideas about self-sustainment. A philosopher named John Rawls described a way to look at society “through a veil of ignorance,” meaning that, would you chose to live in a certain society even if you didn’t know what role you were going to get*.

Anyways, long ramble short, the conference was a really interesting insight into the political portion of medicine. I’m so glad I chose medicine instead of law, because even if takes decades for doctors to regain control of medicine from the insurance companies, there will always be the every-day patients whose immediate problems might be solvable. It will be interesting to see what kind of world baby Jackson will grow into.

If you want to read a little more about these things, here are some decent websites:

*www.colorado.gov/208commission/

*http://www.un.org/Overview/rights.html

*http://infotech.fanshawec.on.ca/faculty/jedicke/rawls.htm

On a side note, YAY Jackson Atlas Leach was born September 12^th, 2007 weighing 6lbs 12 ounces!!!!

Sticking your hand down a stranger's pants

Last week, my small group consisting of Jackie, Christi, and myself, met our “Standardized Patient Examination Teaching Associates,” SPETA for short, and learned how to properly introduce ourselves to patients and how to obtain basic vitals signs- pulse, respiration rate, blood pressure, etc. Our SPETA is an actor in his mid to late forties, trained in ballet and martial arts, who now focuses on his work as a teaching associate for CU. It’s hard to imagine your teacher as anything else, but while celebrating my most recent birthday at The Fort restaurant in Morrison, my mother told the flute player of my entry into medical school, and he told us that he was, in fact, a SPETA as well. I had to chuckle; I guess the kind of personality that likes being probed and fondled by noobie med students isn’t that rare after all. At some point money is money, and at the end of the day, paying the bills can be accomplished by playing the flute, selling your plasma, or even getting your prostate checked.

This last Monday, we had our first official session with our SPETA, learning how to perform lower limb and back musculoskeletal exams. It seemed pretty straight forward as I read down the list of learning objectives- tapping the patellar tendon for reflexes, manipulating the knee to test for ligament stability, examining the spine for scoliosis. And then I read a little further down, to palpating the pubic symphysis and taking the femoral pulse. I’m not squeamish, and I like the fact that in this business I will get to touch people, but I thought it might be a few more weeks before we got into the touching of groins. Conveniently, this procedure was not in the tutorial video that we were supposed to watch before hand.

I walked into our tiny classroom, and there was our SPETA in his little blue and white gown sitting on the end of the exam table, swinging his feet. I felt a momentary twinge of jealousy for other groups that had female SPETAs. Jackie drew the metaphorical short straw and went first. Our SPETA told her what to do, starting with asking the patient to walk a little to observe their gait for limping or anything else. Next, she inspected his spinous processes (the part of your spine that you can feel sticking out of your back) and had him bend at the hips to see if he had any weakness in the muscles of his back. Skipping ahead… he lay down on the exam table, and Jackie palpated his iliac crests, which are what women rest their babies on and what people generally think of when they think of “hips.” If Jackie felt uncomfortable at all when she slid her hands under the waist band of our SPETA’s boxer shorts, she showed no sign. When my turn came around, my apprehension was gone. Maybe it helped that he had some curly hairs on his chest and belly, but he was so matter-of-fact about the whole process, that there was nothing to feel awkward about. Having never found a femoral pulse on anyone, including myself, I had to dig around a bit, but he had nothing but patience.

Today we did upper limb exams, and it was nice to be back in the comfort zone, having enough anxiety about our up-coming test to sustain me for a while. Not that it won’t be intrusive to do these sorts of exams on other women, but I’m glad I have a male SPETA, so I can get over the weirdness of sticking my hand down a stranger’s pants in a “safe place” rather than in the Stout Street Clinic for homeless in a few weeks.

the "only" equation we need to know in med school -----> P=MD
pass = medical doctor

studying already

Our first exam for anatomy (or the Human Body as it's called in block scheduling lingo) is next Wednesday, and already I'm feeling the crunch. Once you've figured out what it is you're supposed to learn, you have to memorize it. When it comes to anatomy this time around (having taken it as an undergrad at Colorado State), the answer to all questions is, "Yes, you need to know it all."

This is me at New Belgium Brewery