Learning in Action

A few months ago I was in a CVS in center city when a man came charging through door, shouting “I need an AED!!”

The pharmacy employees looked back and forth at each other but no one made any actions. The man became angrily impatient, crying out “Come on, there’s a guy dying out there!!”

Before I had really processed what was going on I had set down my basket and my feet were carrying me out the door. I knew that administering CPR can become very tiring very quickly, and having just completed my Advanced Cardiac Life Support course I was as qualified as anyone to lend a hand.

Out on the street I immediately saw a group of people crowding over a man collapsed on the sidewalk. As I got closer I could tell CPR was underway but it wasn’t until I was standing directly over them that I felt a jolt of fear. Though in the past I had seen patients who were very sick and patients who were already deceased, somehow I had made it through three years of medical school without witnessing someone actively dying. The purple color of his skin was frightening.

He was receiving quality CPR from an incredibly fortuitous group of bystanders: A nurse at a local center city hospital and a soon-to-be internal medicine intern were trading off on chest compressions, while coincidentally one of my classmates, Mike Hoaglin, was keeping his airway open and performing pulse checks. I was impressed with how perfectly coordinated the nurse and (almost) intern’s handoffs were- the chest compressions were flawlessly continuous so that any positive pressure build-up in his circulation was not lost as they traded turns. Despite all this it was very clear that he was dying.

Just then the man who had burst into the CVS ran over to us. Out of breath, he managed to report that he had looked everywhere, and asked all the local restaurants and pharmacies, and he couldn’t find an AED. The ambulance had of course been called first thing, but we couldn’t yet hear sirens, and the purple tone of his skin was becoming a sickening gray.

Suddenly a picture flashed in my head of the wall in the mail room of my apartment building nearby. I knew where there was an AED! I jumped up and sprinted down the street, flew into my building, grabbed the AED off the wall, shouted something to the confused doormen, and returned to the scene.

As I crouched down again and opened the AED box I said, “I’ve never done this ‘for real’ before”. No one else had either. Luckily, it was exactly like it had been in ACLS training, and there were very, very simple instructions so that even if I hadn’t been to class I could have easily done it on my own.

With the power button pressed the box immediately spoke to us. ‘Analyzing rhythm, continue CPR’. It was reassuring to hear its automated voice providing instructions.

A few moments later, it spoke again:

“Shock advised. Stand clear”.

The shock sent a jolt through his entire body with enough force to raise his head and send it falling back down onto the concrete sidewalk with a thud. I winced but the AED was unperturbed.

“Continue CPR two minutes”.

Chest compressions were resumed, and before the two minutes had elapsed when it would have been time for another shock, if necessary, the ambulance came screeching down the street. As the paramedics loaded the man into the van Mike said he may have felt a faint pulse after the first shock. I wasn’t so sure.

I headed home knowing we had done our best, and wondering if I would ever find out how the man had fared…

The paramedics contacted Mike the day after to thank us for performing excellent bystander CPR, but they didn’t know the condition of the patient, so it was of little satisfaction.

However, a few weeks later, I received a letter in the mail. It was from the man. He had survived, and had asked his emergency room doctor for our contact information from the paramedics. The letter was three pages long and told me about his family, his job, and his hobbies. It talked about what it was like for him to wake up in the emergency room, and how he has memories of being ‘zapped’ and of people yelling at him to stay awake. It talked about his plans for the next few years and how he can’t believe his luck to still be alive. He also included a $100 check, which I didn’t cash, but plan to hold on to forever.

This story had the best possible outcome, and I really believe it was the AED that made the difference. Despite getting the highest quality CPR I think that early shock was crucial. So, I’m ending this blog post with a shameless plug:

This week Penn launches an amazing new phone application and they are kicking it off with a competition. Using your cell phone, you take a picture of each AED you see around the city. The grand prize for the most AEDs photographed is $10,000!!!!!! But even better, all the pictures you take will be used to create an application that will map the location of AEDs all over the city. Then the next time someone needs to find one, they won’t waste time checking pharmacies and restaurants that don’t have them- they can take out their phone and go directly to the nearest place. What a great idea!!

A Trip to Chi-town for Science!

Dr. Christos Coutifaris, me, Dr. Clarisa Gracia

This past week I traveled to Chicago for the Oncofertility consortium, an annual conference held at Northwestern to discuss advances in the field of fertility preservation for cancer patients. As mentioned in my previous post, I am currently taking a year out from medical school to conduct clinical research in infertility, my field of interest. Oncofertility is an area in which my mentor, Dr. Clarisa Gracia, specializes.

The field looks at cancer treatments like chemotherapy and radiation that are toxic to the reproductive organs. For a long time these effects have been a medical afterthought, as the focus on survival after cancer diagnosis took precedent over other health concerns. But as improved cancer therapies result in better prognoses, it is necessary to consider the side effects associated with treatment. Specifically it is important to think about fertility preservation before cancer treatment begins so that patients may have options down the road for building families. While relatively easy for men to accomplish via sperm banking, for the women that Dr. Gracia sees the options are significantly more challenging and invasive. If there is adequate time before a cancer treatment begins she will work with the patient to bank embryos or eggs. And if there is not time to undergo a stimulation cycle, she offers patients the option of a small surgical procedure in which a piece of tissue from the ovary is removed and stored so that it may be used in the future to obtain eggs. This technology is not yet fully developed, however, and it must be explained to the patient that the procedure does not guarantee that they will be able to have biological children- we hope that by the time they are finished with their cancer treatments the science will have advanced.

I could go on and on about this topic, and being at the conference this week has gotten me more fired up, as I heard directly from all of the people working tirelessly to address some of the concerns of this new field. Basic scientists spoke about the advances in preserving the tissue samples and maturing eggs from them, lawyers and patient advocates spoke about the difficulties financing these procedures for patients, ethicists spoke about important moral considerations as the field advances, and cancer patients spoke about how grateful they were that these options were available. All of the members of the consortium come together each year (and at teleconferences throughout the year) with the idea that if they wait to read each others' papers when published in medical journals then the pace of advancement in the field will suffer. Thus, there was an incredible spirit of open collaboration, group problem-solving, and the sharing of everything from lab techniques and tips to cohorts of clinical research data. As this was my first real academic conference I can't yet say if this level of openness is unique, but it made me proud and in awe of those working in my chosen field.

Now that I have returned from Chi town I'm looking forward to starting a new epidemiology and study design class, beginning journal club for the Doris Duke students, and also working as a student preceptor in Doctoring class. Doctoring is a class for all first year medical students that focuses on the doctor-patient relationship and helps prepare students for life on the wards by addressing topics like cultural awareness and communication skills. Importantly, it is also a place where students can talk openly about the challenges they're facing, both academically and personally, and discuss difficult issues that may arise throughout medical school. My job as an older student is just to listen and occasionally chime in when asked a question about how things work in the wards. My group is incredibly insightful and I was blown away by some of their comments last session. This week's topic is cultural competency and I am excited for the discussion on Thursday!

To the Perelman Class of 2015

My name is Katie Dillon, and I am an MS 3/4. I am so excited to meet all of you MS1s and welcome you to an amazing next four years. I want to reassure all of you that finally, after the months on the interview trail, agonizing over options, and weighing finances, you have made the right choice. I chose Penn three years ago because I was looking for a school that would give me rigorous training (obviously!), but would also allow me to have interests outside of medicine. I was an anthropology major in college and I wasn’t ready to completely give up the reading, writing, and discussions I enjoyed so much. Penn is an incredible place that wants you to pursue your passions and will often pay for you to do so. In the past three years I have traveled to Thailand for research, taken classes for a Masters in Bioethics, played a ton of golf and tennis, hung out at the Jersey Shore, and eaten at many of Philadelphia’s fabulous BYOBs.

Since I’ve been at Penn, and especially after my time on the wards, I’ve come to realize that I am most passionate about women’s health, and I want to be an Ob/Gyn. Right now I’m especially interested in infertility-I think the medicine is fascinating, there is a ton of great research in the field, and there are even some questions that benefit from a little ethics training. This year I am taking a ‘year-out’ and conducting research through the Doris Duke Clinical Research Fellowship. Twelve medical schools in the country offer the fellowship, and I have been lucky enough to get to stay here at Penn and work in the Division of Reproductive Endocrinology and Infertility on a number of exciting research projects with terrific faculty.

I am eager to keep you updated on the progress of all of my activities this year, from my research to my ethics classes (Zeke Emanuel, Rahm Emanuel’s brother, just joined the department!) to use of my newly-found free time now that I’m taking a break from the hospital and no longer working ‘rotation hours’. I hope that you’ll enjoy following along, and I wish all of you a fun-filled orientation week!