Learning to Take in Order to Give

So this is it. I’m officially a real fake doctor now! I have just completed my first clinical rotation. Thus far, I spend 99% of  my time thinking “where am I?” and “am I annoying my resident/intern/attending by being in the way?” and the answers are usually “lost” and “yes.”

I am on neurology and one of our first patients of the morning was a middle-aged woman who had recently been diagnosed with ALS (Amyotrophic lateral sclerosis) a few months prior. ALS is a degenerative neurologic disease that is characterized by progressive loss of motor function. Patients end up losing the ability to move, talk, eat and eventually breathe. This patient had already lost the ability to talk and eat on her own.

My fellow medical student and I went to see her after rounds so that we could get a better idea about what a neurologic exam would look like in someone with ALS. When we got there the patient was in obvious pain and her daughter told us that she wanted morphine. The patient (who communicates now by writing) pointed to her pad where she had written “Ouch. Pain. Help.” Being lowly peons, we don’t yet know how to find a band-aid much less put in an order for narcotics so we quickly left to find the resident (who assured us that the order was being processed by the pharmacy). Given her level of discomfort, there was no way we’d ask her to undergo another exam so I just asked if there was anything else I could do to help. She got out her pad and started writing something.

“How can I help you?” she wrote in painstaking capital letters.

Here was a woman who had just been given a devastating prognosis. She had already lost the ability to speak and her disease will continue to progress, causing her to lose all motor function and die within a few years (median survival is 3 years from onset of weakness). She had been poked and prodded by the medical team, the neurology team and she had just undergone a serious procedure. On top of this she was in serious pain. Yet still she wanted to know how she could help me.

 “I….well…” I didn’t know what to say to this amazing woman. Sometimes medical school stinks. Plain and simple. We don’t have much to contribute at this point in our careers except time and enthusiasm. Our only job is to learn, which makes it feel like an inherently selfish process sometimes. Indeed, I have spent most of this week feeling in the way. Her small act of kindness nearly unbalanced me.

“You are already helping us,” I told her. “We are medical students and this is our first week ever working in the hospital.” She broke into a huge smile.

“We are trying to learn as much as we can from our patients. For example, even though I’ve read about it, you are the first patient I have seen with ALS and I will always remember you because of that. I am going to go home and read as much as I can about it so that some day I can take care of patients myself.” She broke into a huge smile, touched my arm warmly and gave me a thumbs up.

Throughout my first year and a half of medical school I have been blown away by the generosity of those who contribute to medical education:

• My LEAPP patient (a patient who we followed throughout our first 1 ½ years here) whose family let us sit in on her appointments, ask them countless questions and literally invited us to their home.
• Our course director for dermatology who came to speak to my interest group, personally showed me patients during dermatology grand rounds and then spoke about career paths with me for an hour.
• My MS3 “big sister” assigned to me by the Elizabeth Blackwell society who gave me invaluable advice about surviving my pre-clinical years and gave me all the books I needed for my clinical years.
• The MS4 who brought me on board with her project, helped me understand clinical research and is trusting me with presenting our work at a conference this spring.
• Our lecturers and small groups leader-physicians who volunteer their time in order to instruct us on everything from psoriasis to palliative care.
• The resident I worked with in Botswana who taught me how to think clinically about a patient this summer and then this fall coached me through writing a case report that she could easily have written herself.
• The countless patients who spoke movingly and openly to our class about living with cancer, mental illness or rare genetic disorders.
• And now - starting with this patient - all the patients who allow us as medical students to participate in their care.

I know that this is a cheesy story. I know that it’s not possible or advisable to get emotionally wrapped up in every patient you care for. I know that this outpouring of “touchy-feeliness” would earn me an eyeroll from more “seasoned” medical professionals. But I don’t care. And I know that I will remember this incredible woman. I am going to carry her with me throughout my rotations. Because she reminded me that every patient gives me a gift. They give me the gift of sharing their story and helping me learn. I may wear a white coat but for now all I can do is take. Take in the knowledge that is being shared: by the patients and by the physicians, nurses and staff who are helping me learn. One day hopefully I will be able to give something: care for my patients and, if I’m lucky, the ability to teach someone else. But first I need to figure out where the heck I am.

Happy 10th Anniversary to the Botswana-UPenn Partnership!

As I mentioned in my first post, I spent this summer in Botswana working on a study looking at viral contributors to vulvar cancer. The head of the study is Dr. Carrie Kovarik, a Penn dermatologist and all-around superstar at life. I won’t blather on too much about my incredible summer (my other blog: hayleyinbotswana.blogspot.com has enough blathering to last a lifetime) but I will say that it was amazing and that it furthered my determination to make global health a part of my medical career.

Dr. Kovarik speaking about
telemedicine in Botswana

This year marks the 10th anniversary of the Botswana-UPenn partnership: a collaboration between the government of Botswana and the university that has allowed students like me to spend time learning about research and health care in a developing country. In order to celebrate the past 10 years, Penn hosted a Ten Year Anniversary Symposium.

Needless to say, I was incredibly excited for this week’s events. I attended a grand rounds on viral contributors to cervical cancer, a presentation on research in Botswana, a seminar on ICT4D (Information and Communication technologies for development... this is actually an ongoing seminar series) and also a general symposium. While it was cool to hear more about what is going on in Bots, I was even more excited to see some familiar faces: doctors and friends who had flown all the way from Botswana to attend the events!

I also got to attend a meeting about telementoring which is something that I am very interested in. My mentor, the aforementioned Dr. Kovarik, is head of telemedicine for Botswana. While I was in Botswana I got involved with some amazing projects that fall under this umbrella:

• There is a robotic microscope that we would load our dermatology tissue slides into and, via the internet, Dr. Kovarik could control its movements and read the slides from Philadelphia!



We celebrated Cynthia's first
trip to the US with some Philly
Cheesesteak!

• Many speciality services like dermatology, dentistry (and oral pathology in general) and radiology are using mobile phones to take pictures of lesions or X-rays and get expert opinions from all over the world.
• Smartphones are also starting to be used for telementoring: letting residents and doctors have access to medical “apps” that connect them to medical information and to each other.

I am currently helping with a study that deals with the last project and it was amazing to have the opportunity to meet with our Botswana-based constituents: Ryan Littman Quinn (photojournalist extrordinaire/Mobile Telemedicine Programs Manager in Botswana as well as a friend) and the newest member- Cynthia Antwi. The work that they are doing for telemedicine in Botswana is really exciting and I hope to be able to continue my involvement.

Given that we are currently in our renal block (fabled to be one of the hardest parts of the pre-clinical curriculum)... my brain is currently full of ions. I can’t tell you how refreshing it was to be able to stop thinking about potassium transporters and think about how to improve access to healthcare!

Earthquakes, and Hurricanes, and Cardio... oh my!

So it’s back to school for the MS2s and it seems that our arrival doesn’t sit well with Philadelphia: since our return there has been an earthquake and a hurricane. The earthquake happened while we were in a doctoring lecture and I didn’t feel a thing. Very disappointing for a born-and-bred east coaster who has never experienced an earthquake... darn the sturdy construction of John Morgan!

In slightly more exciting news... Hurricane Irene came and went this weekend. The media had us convinced we’d look out our windows to see the four horsemen of the apocalypse riding down Walnut Street so I dutifully stocked up on necessities: batteries for my flashlight and some mini Snickers. But despite doomsday predictions of power outages/dangerous winds/flash floods, everyone I talked to reported much the same thing: it rained for a bit and then it was pretty windy.

Après storm my roommate and I decided to head down toward the Schuylkill river trail: a popular running/biking path that winds along the river (whenever I jog there normally I am guaranteed to run into at least 5 other med students). When we got there it was almost completely flooded and an hour later we were up to our waists in water! I hope that my MS3/4 friends are studying up because my little adventure may have left me with a case of Schuylkill-itis.

Above is a picture of the path pre-hurricaine (courtesy of Google images).

Below is me frolicking in the exact same section of the path on Sunday:

Other than that it’s been business as usual for the MS2s: we’ve dived into cardiology and are working our way through understanding EKGs. Before the hurricane we also had our annual big/little sister matching event for the Elizabeth Blackwell Society (for female medical students). We paired each MS1 with an MS2 “sister” that is supposed to give them advice about school and just be a friendly face in the hall. I adore my big sister and I’m also one of the heads of EBS so I was worried about how it would go but I think a good time was had by all and I’m excited to get to know my (2!) little sisters this year!

Back to School

Hello all!

I would like to take this first post to quickly introduce myself but also to wish the new first-years a warm welcome. I couldn’t be happier that you are all here-now we are no longer the lowest on the totem pole. Kidding, of course. I hope and trust that you’ll like Penn as much as I have. I think that you start orientation soon which is actually awesome (and believe me, I went into it with a lot of eye rolling) so have fun and we can’t wait to meet you!

And of course welcome back to my fellow 2014ers, I hope all of your summers have been amazing. From the Facebook posts and emails I’ve been getting I think that’s the case: surfing in Nicaragua, planning a wedding, volunteering at a clinic, learning acupuncture in China, working with refugees in Philly, working with an oncologist in NYC-and that’s just my learning team. To the 2013/2012ers, I don’t need to welcome you back as you’ve been working your butts off whilst we young-uns have been gallivanting around enjoying the last bits of freedom before we delve into the abyss that is cardio/renal etc.

Using VisualDx Mobile with some pediatric residents in derm clinic

OK! Now on to more important things-me :) Who am I? My name is Hayley and I am just starting my second year at the Perelman School of Medicine. I am originally from Boston, went to Brown, graduated on 2009, took a year off and worked in Malawi before heading to Philly for med school. I will be blogging my way through the year in order to give everyone a glimpse of what life is like for one PSOM-er.

I am currently writing this post from Botswana where I spent the summer (you can check out my adventures at hayleyinbotswana.blogspot.com) doing dermatology work at Princess Marina Hospital. Penn has a fantastic partnership with Botswana and I have had the most amazing summer. As I wrap up my time in Bots and prepare to head back to school I thought I’d end my first post by letting you know what I am looking forward to this year and what I am dreading:

• Absolutely dreading heading back to my apartment because I know that in my haste to leave, I dumped all my (clean) laundry on my bed without folding it. What a welcome home present for myself. Ugh.
• Can’t wait to get some Yogorino on Rittenhouse Square and watch all the cute puppies.
• Not excited about trading this perfect Botswana weather for the heat wave I’ve heard about in Philly.
• Pumped about planning some events for the Elizabeth Blackwell Society (for female medical students) as well as visiting Covenant House (teenage homeless shelter in Germantown, PA where I volunteer with a few other med students).
• Very very scared to begin our cardiology block: it has a reputation of being extremely tough. I know that I will be fine once I start but I’d be lying if I said I wasn’t a bit nervous.
• Happy to re-start Pilates classes. Africa and exercise didn’t mix as much as I’d hoped.
• Mainly I am so excited about seeing all of my friends and hearing about their summers. As I mentioned above, I have been blown away with the updates I’ve been getting via the interwebs so I’m eager to hear about it in person.

Signing off for now!