“If you could only see what I have seen with your eyes”

So goes the quote from Bladerunner. But it's not about sci-fi cinema today, but about ER. Just finished up the first of 4 stints shadowing an ER physician which are part of an Intro to Emergency Medicine class. It's a nice chance to see the real world before we become a part of it, more than a year from now as rotations kick in.

While most of my classmates opted for the local trauma center, I said either that or the swanky suburban hospital was fine with me. I'm just here to check things out, see if the emergency thing may be in my future. Someone must have figured out that I'm a man of the suburbs, and I got the posh hospital. Still, an emergency department is an emergency department, and I've seen what I came to see. It started of with rather banal things: headaches, dizziness, a case of bleeding hemorrhoids, but towards the end, things kicked into high gear with congestive heart failure, malfunctioning heart pump, and non-Hodgkins lymphoma. Best of all, I saw the procedures that I wanted to see. IV lines being put in, catheterization, and a blood draw from the femoral vein (right near the groin, ouch!).

My ER preceptor is a nice, laid back guy. Very human with the patients, yet able to project the doctorliness in a professional manner. Residents were also cool, one of whom decided to give me some education while the doc was too busy. Now I have a few things to look up as "homework." Good stuff.

Back in my day...

I do get so say the words of today's title sometimes, and for effect, I deliver them with the old man voice. Though we won't be talking about the ailments of the elderly today. No, quite the opposite, we'll take a look at the technology available to a student these days.

First off is the indispensable Facebook. The first semester it was really all the rage (this phrase was used back in my day), although things cooled off by now a bit. It's especially funny to see an almost complete loss of activity the day before any major exam. Which brings us to email, which seems to be always used, even before exams, for various distractions. At least one or two posts to the class distribution list will be about this or that "study break," usually something someone found on YouTube, usually related to medicine.

OK, so internet is mostly for wasting time, but we do have lectures available there. Since the material is so dense, it's nearly impossible to take good notes, unless the official class notes are well done, which varies from professor to professor. This has been pretty much taken care of by lecture notes, and now lecture videos, available within a few hours after the actual event takes place. So if you want to sleep in, crash your car on the way to school, or just plain feel like reviewing that dense professor's lecture one time, there they are. Which makes me feel spoiled rotten, since when my friends were attending medical schools in the last century, they only had a note-taking service.

A writeup on technology in medical school wouldn't be complete without some kudos to the network and PC guys who make the wireless infrastructure, computer labs, and the basic internet access possible in a nearly flawless manner. I left that world ages ago, it seems, but I do appreciate all the work that goes into making that flawless appearance.

Onto things more medical. While we may have been still using real cadavers, all this in the days of virtual frog dissections for the squeamish 8-th grader, some of the more classical material has already been delivered virtually. A complete histology course, developed by one of the professors at the university, was done on a computer. No microscopes, no slides, just images on a PC screen with cursor-sensitive areas. Going over portions of a cell with a mouse would highlight various organelles, etc. Endoscopies of all sorts will also be done virtually. Apparently we'll be able to perform colonoscopies through a computer program. There is also a virtual patient that we were shown during the orientation. I forget what he's for, though I do remember that he can be made into a she with appropriate attachments.

One final technology note is that I have yet to see one Tablet PC, which was heralded a few years ago as a revolution in higher education. Now that everyone's got their Powerpoint notes printed out, it looks like the TPC is a technology that came too late. A bit like Blu-Ray, which might not matter to anyone in the days of downloadable music and movies.

On a lighter note.

Why is poop brown? Bet that question has been dogging mankind for centuries. For a mere $20,000 in first year's medical school tuition money, you can get your answer. The more budget-oriented answer seekers may always turn to Google. Wonder where Encyclopaedia Brittanica falls in this spectrum of knowledge authority...

Anyways, the answer is bilirubin, which, to make the long story short, is the end product of hemoglobin breakdown. Along the way, it ends up being slightly modified, excreted with bile into the gut, and voila, there's brown poo. Now back to studying.

For obvious reasons, no picture with today's blog.

More food.

So I just found out that, none other than the US Army will be giving a lunchtime presentation this Wednesday. And they're aiming to recruit doctor soldiers with sushi, rice-crusted chicken, and subs. War in Iraq? Who cares, they're feeding me sushi. Where do I sign up?

Pizza and flesh wounds.

Once the school year is in full swing, lunchtime presentations abound, and typically there is food involved. Oftentimes it's the healthiest of choices: pizza. But the more "prestigious" seminars have things like subs, wraps, or Panera Bread sandwiches. Today the Emergency Department was showing off the effects of trauma, so keeping with the bloody color theme, they served up a boatload of pizzas. And pop, naturally. Ironically enough, that's what we're trained to tell patients to avoid to maintain weight control--drop the pop down to one can per day, and limit the fat intake. But anyways, we're all slim future doctors, we could use some extra fuel, right? And they bash the smokers.

So the presentation showed photos that I obviously can't share, but mixed among the various types of trauma, we had motorcycle driver who crashed into a concrete post and was split in half. Next up was the classic, but still much-beloved self-inflicted gunshot wound to the face. Biggest problem there was finding the airway, since the face was unmistakably gone. Yes, this does bring up the main thrust of the presentation, which was the ABCDE prioritization scheme for trauma patients. Airway, Breathing, Circulation, Disability, Exposure. Anyways, next up were the frequent but oft-misunderstood stab wounds. Mostly to the head, but rarely knives. X-rays generously illustrated the extent of the object penetration in case the photographs didn't make it clear. The grand finale was of course missing limbs and digits, with some tips on what to do with the amputated parts to preserve them for the surgeons. All the while, about a 100 people were munching down on pepperoni pizza.

Later on in the day, we were learning the eye exam, part of which was the technique to flip the upper eyelid. Someone was very queasy with that exercise. I guess they didn't attend the lunchtime seminar either...