I don’t know how often I will be able to post, but I’ve decided to take a cautious step back into blogging. I’ve been “lost” in the nebulous time between second and third year of medical school that involves a combination of boards studying and transition to clinical rotations. Meanwhile, I haven’t had the chance to continuously indulge the various topics and issues that interest me beyond the immediate academic content of our curriculum. Even as I head deep into my first rotation on the wards, I’m not sure what my relationship with social media will look like. Nevertheless, it’s been a long day on the wards today (emotionally both amazing and exhausting) and this is part of a recovery process that included a run along the Baltimore harbor (quite therapeutic) and a bit of playoff basketball. This isn’t a promise for the regular updates that happened earlier this year, but it’s an experiment to see how this e-version of me can mesh as the “real me” moves into a new stage of my training and life.
Atul Gawande writes on how success involves the recovery from failure:
Scientists have given a new name to the deaths that occur in surgery after something goes wrong—whether it is an infection or some bizarre twist of the stomach. They call them a “failure to rescue.” More than anything, this is what distinguished the great from the mediocre. They didn’t fail less. They rescued more.
Click-through to read “Failure and Recovery”: http://nyr.kr/LeJ3GV
From LeBron James’ Twitter. #WeAreTrayvonMartin
The Atlantic: The Decline of American Nationalism (Or, Why We Love to Hate Kony 2012) -
Three weeks ago, a small group of idealistic 20- and 30-somethings in San Diego tried to spark a national conversation about Ugandan warlord Joseph Kony. Their video campaign, Kony 2012, got millions of Americans talking, but about something different. The conversation that people ended up…
(Source: The Atlantic)
Spring Equinox 2012
In Mexico, thousands of people travel to Teotihuacan (and other sites around the country) to celebrate the spring equinox (usually around March 20). In particular, they go to the Pyramid of the Sun (La Pirámide del Sol) and stretch out their arms towards the sun. Furthermore, the sun’s rays are said to hit a particular point on top of the pyramid, which many visitors touch to absorb the sun’s energy.
For a first-time visitor to Mexico, Teotihuacan is definitely worth your time.
On a separate note, please send out your prayers to Mexico in hopes that everyone is safe after today’s 7.4 earthquake. Espero que todos estén a salvo..
Also, some past posts on my summer in Mexico..
One world, one language?
Big & small
For those of us who love to travel, the list of places to visit can be daunting. Moreover, the expenses of traveling can be quite formidable. Fortunately with the advent of HD video, we can whet our appetites with some great video montages.
So this is what it feels like to have a rush of adrenaline in crisis—a potent mix of excitement and panic.
I yelled out the patient’s name and shook him. No response. The only sounds were the shuffling of the sole nurse at the foot of the bed and the electronic hum of the myriad medical machines decorating the room. I slammed my fingers into the patient’s carotid arteries. No pulse.
As I called out for a code blue and started chest compressions, I began running through a mental checklist. A week ago, I absolutely would not have been able to call up this list of next steps from memory, but this day—to my utter relief—it was there when I needed it, in the midst of racing thoughts and a pounding heart. I heard my voice rattling off orders for a backboard, stool, bag-valve mask, and heart monitor, though I was convinced that the real me was paralyzed with uncertainty and inaction.
V-fib appeared on the heart monitor, and shocks from the defibrillator followed as I had the nurse take over chest compressions and I navigated the forest of wires and pressed paddles onto the patient’s chest. Thump. Silence. Restart chest compressions. Thump. A pregnant silence. A long moan. The patient was back.
A disembodied voice came over the intercom: “You’ve saved your patient. Good job.” End of the simulation. I exited the room, leaving the robot patient with a mess of tubes and wires hanging from its plastic body. Out in the hallway, I wondered: what had just happened over the past ten minutes?
This has been the story of the past three weeks. As second-year medical students at Johns Hopkins, my classmates and I have been in a nebulous stage of our training called “Transition to the Wards”—a point at which didactic lectures are in the rearview mirror while the anticipation of entering the hospital wards looms. Through a series of diverse training modules, we spend this time evolving from medical students wading through books to members of a patient care team with full-blooded responsibilities. Suddenly the theoretical becomes practical, the “nice-to-knows” become “must-knows,” and simple clinical scenarios become ethical dilemmas. The vicissitudes can be quite intense: one moment you feel ready to save a life as you stand triumphant over a mannequin, then suddenly you’re hovering in the pediatrics emergency department hearing the gurgle of a seizing child and feel completely helpless to handle such situations.
Nevertheless, you begin to sense that these highs and lows will eventually even out. All the concepts we have learned over the past year-and-a-half will gel and become useful in caring for a patient. The awkward history-taking and physical exams we have had with various real and standardized patients will become more natural. Above all, we will learn that medicine is ultimately a long, imperfect, and continuous process. Nothing is guaranteed except that through the steady infusion of time and preparation, we can minimize uncertainties and shortcomings. At first, the art of patient care will elude even the most knowledgeable medical scientist. Then somehow, with time and repetition, it all comes together. As surgeon-author Atul Gawande writes in Complications, “Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you’ve got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.”
Over the last three weeks, we have had a potpourri of training from placing Foley catheters and IVs to debating malpractice to managing patients’ electronic records. Now, we leave our medical education building for the hallowed halls of the hospital—just a little bit wiser, still apprehensive, but surer about the path that we are on. I expect we will continue to have moments at which we suddenly have an implicit understanding of what needs to be done in a given situation, and wonder when that flip was switched. However, I also suspect that no one will ever actually reach a point at which he or she feels there is nothing else to learn or master. Gawande writes, “No matter what measures are taken, doctors will sometimes falter, and it isn’t reasonable to ask that we achieve perfection. What is reasonable is to ask that we never cease to aim for it.” We cannot become the “perfect physician,” but we can establish a pattern of continuous learning and improvement that generates iterations of a “more perfect” physician.
So it all starts now as we seek to become the physicians that we always dreamt of becoming, weaving individual concepts and skills into a masterful patchwork quilt for patient care. It is only the beginning, but the road ahead is clearer than it ever has been before and that is exciting. Transitioning is an ongoing process, and we charge forward towards the hospital knowing that each step will prove to support the next.