Friday, February 3, 2012

Across the Pond

Since I was a senior in college, I have wanted to spend time in London to conduct research. Sounds a bit odd I'm sure. Perhaps you thought I was going to say I wanted to spend time in London to watch football (that's soccer for you yanks) or to use it as a springboard to explore Europe. While I'll certainly be using my time in London to catch Arsenal matches and take advantage of cheap rail and airfare around Europe, my official reason for being in the UK is to conduct the research necessary to complete my master's thesis for the MTR program, one of the many dual-degree opportunities at Perelman.
From the south bank of the Thames River 
I am currently a visiting research fellow in the Department of Surgery and Cancer at Imperial College London's St. Mary's Hospital, where my work is supervised by Professor Ara Darzi and Dr. Rajesh Aggarwal (though in the UK, surgeons liked to be called "Mister"). My area of research is in surgical education and simulation, and the labs investigating surgical education and technology at Imperial College are some of the most prolific in the world, collectively publishing over a hundred papers every year.

The simulation facilities here are top-notch, though Penn's simulation center is just as impressive. St. Mary's boasts a virtual reality lab with multiple virtual reality laparoscopic and endoscopic trainers that allows trainees to receive highly detailed metrics of their operative performance. Furthermore, the simulation center is equipped with a cadaveric porcine lab to let trainees practice procedures on pig tissue, a fully simulated operating theatre, and a state-of-the-art simulated endovascular suite (the only one in the world). The inner tech geek in me, which I admit is actually the outer tech geek, nearly passed out when I was introduced to all of the equipment.

If med school doesn't pan out,
there's always Hogwarts
In August of 2011, I met Salaj, a medical student from King's College London through Perelman Med's Peer Hosting program. The Peer Hosting program connects visiting medical students from abroad with a current Penn medical student to help them get acquainted with Philadelphia. Salaj and I became quick friends during his time in Philly; and since I arrived in London, Salaj has been a wonderful host, showing me around London and introducing me other students at his medical school. I'm fortunate that Penn gave me not only the opportunity to come to London, but also provided the opportunity to make friends here before ever leaving the States.

I have much to look forward to in my remaining 8 months here: the Queen's Diamond Jubilee, Wimbledon, and the Summer Olympics. With over half a year to go, maybe I'll finally learn to look for cars driving on the left side of the road whenever I cross the street. My top priority, however, is picking up a posh British accent; I figure it is one of the most useful skills I can acquire before going back to the US. That being said, I don't think I'll ever learn to spell like a Brit. Dear Britain, it's spelled "esophagus" not "oesophagus."

I'm certain I'll have plenty more to write about London Town and British quirks that I find amusing. Until then, hope all is well in the colonies.

Olympic rings welcoming visitors to Kings Cross Station

Perhaps when I'm eventually an attending I can
get a suit from one of the famous tailors on Savile Row

Sir Alexander Fleming discovered penicillin at St. Mary's Hospital,
and the 2 million signs around the hospital won't let you forget it.
I guess it's the same as Penn's love of Benjamin Franklin...

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.