Reality.

It's been a while, but we've finally been treated to a patient presentation. The GI module had a patient back out, so we just had a dry recitation of facts, and that only on one occasion during an almost two-month battle with the stomach. Renal has come through for us, and we had probably the most touching meeting with a patient today.

Today we met a woman who went through many years of hardship and two kidney transplants, but ended up beating the odds and living well beyond the 50-year-old lifespan that was predicted by the doctors in the 80's. Being in sales, she was very comfortable with the audience and told her story without any assistance from the professors who typically guide the process along.

It was remarkable to be thrust into the reality of the patient's experiences where we would normally talk about transplantation techniques and immunosuppressive drugs. In my computer past, it was remarkably easy to put oneself into the users' shoes and try to look at things from a perspective of someone who wasn't familiar with technology. It's quite a different thing to find yourself confronting a patient who needs not only non-technical language, but also a simple human consideration for their emotions and fears. Our patient went through years of dialysis, and two kidney transplants. The second transplant worked out, and today she is reasonably healthy, though she will be immunosuppressed for the rest of her life in order to maintain the kidney.

We often hear about transplants or dialysis in a "no big deal" type of context. These words can become routine, yet they provide an umbrella for so many individuals, each with a rather sad story to tell. Although I don't know the statistics, I do hope that the first time transplants work out for majority of the patients.

Room 237

On the way to the computer lab, where more work awaits following the grueling Monday schedule, I chanced upon room 237, which is the server room. Definitely something from the past, funny to find it here, so close to the realities of medical school. We actually do have a demanding setup that would necessitate a sizable server and infrastructure support, so no surprise there. Back to work.

Timing, all timing

Had to work Scrubs into this blog somehow. Hmmm, medical student watching a medical comedy, how rare, eh?

We've bought a few things from Circuit City over the years, and using their rewards card, we've accumulated some points that can be traded in for some discount coupons. Considering that the company has been in trouble trying to compete with Best Buy and shrinking margins, I decided to turn in my points for all the coupons I could get. I figured I'll hang on to the coupons for when CC will have their predictable sale that'll follow the release of the newest Scrubs DVD set. I shot for around September/October timeframe. $20 for new set, $20 for back sets, which normally sell for $35-40. CC can't go out of business by then, can it?

Well, this weekend the coupons have arrived, and unfortunately, their expiration date was all too soon: July 9th. OK, the immediate disappointment turned into Obama-like hope that maybe during the summer months' slow sales, there will be some sort of an across-the-board price cut that'll include Scrubs. Realistically, though, I dreaded that I'll have to take what I'll get in the nearest two months.

Looked at CC's flyer for today, and surprise, surprise: all Scrubs collections on sale. Couldn't have asked for a better timing. Yay!

U/S

In the spirit of the renal exam, another kidney image. This time in ultrasound. Having actually learned how to do u/s today, I'm quite amazed at this picture, but we were told that it takes around 50 exams to get good at this thing. We were fortunate enough to have had eight volunteers, a few of whom were on abdominal dialysis which allowed us to view abdominal fluid pooling, something that u/s is very good at.

The primary advantage of the u/s is its rapidity. You turn on the machine, put the gel on the transducer, and you've got 60 seconds to do the FAST exam in a trauma setting. FAST is Focused Assessment with Sonography for Trauma (yeah, someone really tried fitting things into this acronym). It's designed for ultrafast assessment of abdominal injuries, but it also extends to the heart. The primary limitation should be obvious from my above comment: it's hard to obtain good, clear images.

A normal ultrasound scan will take longer, but since we're talking emergency medicine, things need to happen quickly, especially when there is some severe trauma like stab or bullet wounds. There is also some discussion in the medical circles as to the possibility of the venerable stethoscope being replaced by ultrasound in the near future.

A month already?

And it's been a busy month. It's odd to admit, but I'm studying now more than ever. The volume of material is simply incredible, once you wake up to the fact that what used to be anatomy lab, sometimes 3h of it in a day, is now 3 separate lectures. So lots of reviewing and re-reviewing has to go on.

So, we've sailed past the gastrointestinal module, which granted us such arcane knowledge as the secrets of two types of diarrheas you can get, the very specific difference between diarrhea and dysentery, and why you'd rather have IBS than IBD. The really pressing stuff like what does a colostomy bag feel like, and what is the composition of a standard flatus has been left for the eager beavers who will become GI docs. Due to time constraints (6-year residency) I will likely not be a part of the club, so I may never know the answers. Well, there is always Wikipedia.

So on to the renal module, hence the picture of the kidney outlines on the patient's back. Notice that the left kidney is higher than the right. This is due to the space taken up by the liver, along with the fact that the right lung is a bit longer than the left.

Like GI, the renal module offers a jolly mixture of how the stuff works and how it goes bad. It's all a bit like a movie that at first sucks you in and makes you feel good, but then your favorite character is killed off. And so far, all the characters in medical school have been quite likable. Hate to see what happens to the muscles in the upcoming musculoskeletal module.

The first renal exam is on Monday, just 3 days from now. Although it's Friday today, I'll be seeing the family tomorrow after lunch. We have an ultrasound clinic tomorrow morning, so I arranged to stay at the university, study in peace, and come back a bit later. It should work out well. And next week, thanks to the wonderful recorded lectures, I'll take off for home early.