LOOK GOOD FEEL GOOD TEST GOOD

Katherine Donches

Lewis Katz School of Medicine Class of 2018

It’s a week before exam day, now starts the stomach pain

There is no way I can fit all of this stuff into my brain

Why does an hour long lecture have 200 power point slides?

Do I need to remember which drugs have amines and which have amides?

And despite using blue backgrounds with yellow text, our lecturers get paid

To teach us information that is not found in First Aid

 

It’s the night before test day, and I’m going to bed early

Trying to remember if its basal or squamous cell carcinoma that looks pearly

Laying in bed, mentally trying to draw the brachial plexus

Definitely not ready for this exam, I resign myself to a residency in rural Texas

Turn the light back on to look up which sketchy video features a disease involving sheep

At this rate I’ll be lucky to get 3 good hours of sleep

 

It’s the morning of exam day, my stomach makes that clear

Taking shots of pepto bismuth like they are everclear

I grab my laptop and give ExamSoft a double click

Every passing moment I feel slightly more sick

*side note: does anyone else panic and instantly forget how to use Exam Soft every time they open it on test day and painstakingly read the instructors, worried you’ll take the wrong test or it won’t save?

My palms are sweaty, knees weak, arms are heavy

I’ve done all I can for this exam, I really hope I’m ready

 

Its five minutes after the exam, everyones moved into the hall to complain

“I wasn’t sure if the guy in question 30 was still normally grieving or actually insane”

My favorite part is when a lecturer says ‘you’re not responsible for this’

and then it pops up on the test four times, all of which we missed

Finally, after a full week, I’m no longer feeling queasy

Even when I talk to that one annoying student who says the test was easy

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Above image taken from: https://www.pinterest.com/pin/110760472060231904/

 

 

Ambivalence

Akshay Shanker

Lewis Katz School of Medicine Class of 2020

The first day of Anatomy was a strange mixture of two worlds—of nervousness and expedience, of caring but ultimately not. I remember being stressed not only about the assignment we had to do that day, but about the experience of being in a room with dozens of people who had perished in the near past. I changed out of my normal clothes, put on my blue scrubs, walked through the sea of formaldehyde, and started to wear gloves and a gown as if I was a surgeon scrubbing into a routine procedure. Inside though, I had no idea what to expect. In clear and concise language, our dissection guide told us that “the trapezius and rhomboid muscles should be separated from their origins on the vertebral spinous processes and reflected laterally toward their insertions to expose the thoracolumbar fascia.”

Scalpels and scissors in hand, we begin delving into the layers of our donor’s back as if nothing significant had happened. After all, we were medical students now; we had a goal to accomplish and a lab to get through. Despite how many times I told myself it was, it just didn’t feel real…perhaps I have not had enough experience with anybody terminally ill in my family to realize that, for all intents and purposes, the person laying on our table could easily be them. There was a 22-year-old two rooms over; his hands may have grasped the same iPhone or his feet may have walked in the same shoes.

It is both a privilege and a form of professional development to act maturely around such a surreal subject. Many of us had come straight from undergraduate colleges, our last real commitments involving cramming for papers and enjoying drinks with friends. Suddenly, a few weeks into medical school, I was holding a brain at 9 A.M on a Thursday, using my thoughts to conceptualize the fact that I was holding an entire lifetime’s worth of desires, tribulations, childhood memories, and experiences within my palms. We become eerily aware of physiological variances within our donor’s body, not realizing how these processes may act in our own as we progress through medical training as well.

“…for the most part, I didn’t feel anything.”

But before acting as if I became some philosopher throughout the course of this class, I will be honest and say that for the most part, I didn’t feel anything. At times, I had short feelings of revulsion, but those were more than compensated by the many instances where I found myself feeling numb during things as serious as bisecting a skull.

 

Intern Burnout – Part 1

Adys Mendizabal, MD

PGY 1 Neurology Prelim Pennsylvania Hospital/Hospital of the University of Pennsylvania

Lewis Katz School of Medicine Alumnus, Class of 2016

The results of the recent presidential election have been troubling for many Americans, and have left the medical community with a great deal of uncertainty. What will happen with the Affordable Care Act? Will it be repealed altogether? How will this affect our patients? What of insurance coverage? And how about medication coverage?—Now, this last question I find to be the most provocative of all.

I’m a first year internal medicine resident/neurology preliminary intern, but my experiences with healthcare systems started from a young age back in Cuba, where my dad practiced as a physician.  In those days, common medications such as antibiotics or blood pressure medications were relatively easy to find and free of cost; however, the downside of a communist system is that the not-so-common medications were simply not available anywhere on the island. So yes, medications were free of cost…as long as you could find them.

We later moved the United States, the Mecca of healthcare advancements, latest medical discoveries, and the creation of novelty pharmaceuticals to treat some of the most disabling conditions. Yet, in this same Mecca, the price of such groundbreaking pharmaceuticals is prohibitive to the average and even the not-so-average American. Oh, and these high prices are not only for “novelty” or “designer” medications, but also for some of the most common and life saving medications. Here are a few examples of medication costs and some anecdotes I’ve gathered through my training:

Albuterol Inhaler ($58-65):  Rescue medication during an asthma exacerbation.

I was diagnosed with exertional asthma during the first year of medical school. One day I was going up a flight of stairs and I felt short of breath. Later that evening, I was walking around a free health clinic during orientation and I simply couldn’t stay standing for long because of the shortness of breath.  Subsequently, I was diagnosed with asthma, and I was prescribed an albuterol inhaler. When I went to my local Rite Aid to pick up my prescription, I found that, even with the school’s health insurance (which was about $220/month), my prescription was not covered; instead, I had to pay the $60 out of pocket. Sure, that may be pocket change for many. But for the average family in North Philadelphia, $60 for asthma treatment might be $60 they can’t afford.

How about foregoing the inhaler and just taking my chances? Well, a severe asthma exacerbation, not treated with an inhaler, will lead to an ED visit (best case scenario), an intubation, or hypoxic event leading to cardiopulmonary arrest, aka death.

Lantus ($200):  Long-acting insulin for management of diabetes. Administered at night in order to achieve good glycemic control first thing in the morning (which is the main goal in the management of diabetes).

Here I am during my third month as a “newly-minted” doctor. It’s my sixth week in a general medicine inpatient service. One of my patients came in with complications of a newly diagnosed autoimmune vasculitis, which required high doses of steroids. Steroids cause your blood sugar to skyrocket, so this patient also suffered steroid-induced hyperglycemia, which requires insulin use. As I’m finalizing the discharge paperwork, I give him a script for Lantus (9 Units, a very low dose), a drug that many of our patients with diabetes are prescribed in the hospital.  The following day, as I’m running around on a typical stressful day on the general medicine ward, I get a call from the patient’s wife, saying that WalMart was charging them $200 for insulin. My jaw dropped. I have ordered Lantus nearly every day in the hospital setting, and yet I had no idea that such a commonly prescribed medication cost my patients so much.

“I have ordered nearly every day in the hospital setting, and yet I had no idea that such a commonly prescribed medication cost my patients so much”

I spoke with one of our pharmacists who recommended NPH, an intermediate-acting insulin, typically covered under the “$4 plan” at Walmart (which actually costs about $20-$30).  Furthermore, this replacement medication comes in a vial, so the patient needs to have access to needles in order to even take his medicine. Needless to say, the patient’s “diabetes education” training only showed him how to use an insulin pen, not the vial, and the patient’s wife understandably felt very uncomfortable drawing insulin from the vial since she had never been educated on the procedure. After speaking with the pharmacist, I was able to contact our hospital’s outpatient pharmacy, which could sell my patient insulin pens for Levemir (another long-acting insulin) for $60.

In case you’re wondering how insurance factors into all of this, this patient was on Medicare, but without the Part D coverage, so his medications were not covered.

Tenofovir($1000-1142 for a 30-day supply):  Antiviral medication used for treatment of HIV and to prevent Hepatitis B re-activation.

It’s often said that autoimmune conditions are like “birds of a feather” in that, if a patient has one autoimmune condition, he/she will likely have another.  Take for example, the above patient, who not only had an autoimmune vasculitis, but had also developed hemolytic anemia that was likely of autoimmune etiology.  When he saw a hematologist about his hemolytic anemia, he was told to try taking Rituxan, an immunosuppressant.  While Rituxan would help keep this patient’s immune system in check, and hopefully treat his anemia and vasculitis, the dampened immune response could allow Hepatitis B reactivation in a patient with a previous Hepatitis B infection. Since this patient was going to receive six weeks of Rituxan (one cycle, once a week for six weeks), we also placed him on Tenofovir in order to prevent Hepatitis B reactivation. In this scenario, the patient only needed one pill, once a week, for a grand total of 6 pills over the course of his treatment.  Yet, when the patient’s wife went to fill his prescription, she found that they were being charged $1000 for Tenofovir.  I contacted Walmart, where they were filling the prescription, and their pharmacy explained that they are unable to break the bottle (30 pills), so the patient would have to buy an extra 24 pills for $1000. Once again, the hospital’s outpatient pharmacy came to the rescue.  They offered to sell the pills individually, as the inpatient pharmacy often had to break the bottle and dispense Tenofovir in smaller quantities.  Even then, when the patient filled his prescription at the hospital’s outpatient pharmacy, he paid $40/pill for the 6 pills, amounting to $240.

Keep in mind, this is a retired family living in the suburbs of Southern New Jersey.  Not the poorest of the poor, just your typical middle class patient.

Zonisamide ($14-60):  Medication for treatment of epilepsy. Well-tolerated, with minimal side effects.

In the neurology clinic, I saw a 24 year-old female patient with a history of migraines, seizures, and bipolar disorder. Previously, she had tried two seizure medications, one which sent her into severe depression and suicidality requiring her hospitalization.  At the time of her visit with me, she was on Depakote, a highly teratogenic medication that we try to avoid in women of reproductive age, because of its risk of causing neural tube defects during pregnancy.   Therefore, we wanted to start her on Zonisamide this time around because it not only had the potential to help with both her migraines and seizures, but also it’s a well-tolerated medication, with minimal side effects.

The next day I got a call from the patient saying her insurance did not cover Zonisamide. I looked into it and found that Walmart sells Zonisamide for $14, so is there really a good reason for her insurance company to not cover it?

I tried contacting her listed insurance company, which replied that the patient wasn’t enrolled with them, but was instead enrolled in a different health insurance plan.  Now, our records showed that the patient hadn’t been with that second company in a year, and lo and behold, when I contacted said company they verified that the patient was not enrolled with them.

Now there are two practical issues in this scenario.  On one end you might say, “well, call the current health insurance and ask them to cover it,” but at this point, I had spent one hour on the phone with not only multiple health insurance representatives, but also the patient who said “I’m currently working, I don’t have time to try to sort this out right now.” I was able to find the medication at Walmart and with a coupon it would be $14 for a 60-day supply which the patient agreed to pay. But in the practical, very busy world of an intern, that one hour on the phone felt like an eternity, and it was immensely frustrating. On the other hand, why would the insurance company be unable to cover a $14 medication? And if I had a difficult time sorting out coverage for the patient, imagine the patient herself, a working mother, trying to navigate the healthcare system to advocate for the coverage of her own medications.

___________________________________________________

When we say “medical residents are burned out and jaded,” there are numerous causes for that, but for me, I can tell you the biggest culprit for my burn out in the last six months has been medication costs, lack of insurance coverage of medications, and wholesale retailers and commercial pharmacies overcharging for the medications my patients need. I feel frustrated, stressed, and angry every time I need to spend an hour calling insurance companies, contacting pharmacists to discuss alternate medications, and faxing prior authorization forms because guess what, that’s not what we signed up for when we applied to medical school. That hour is an hour that I could have spent providing direct patient care, such as spending an extra 5 minutes to get to know my patients better, properly educate them on their medical conditions, and treatment plans. It’s also frustrating to know that the medication that will best treat my patients’ condition will be a medication that they can’t afford.  Finally, it’s especially frustrating when my patients can’t actualize their right to be healthy because of big pharmaceutical companies overcharging for medications and health insurances refusing to cover life-changing medications.  

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Medication costs taken from: www.goodrx.com

Images taken from:  http://www.health.harvard.edu/blog/why-many-generic-drugs-are-becoming-so-expensive-201510228480, http://www.shape.com/blogs/shape-your-life/your-doctor-burned-out

 

Kate’s Surgical Rotation Survival Guide

Katherine Donches

Lewis Katz School of Medicine, Class of 2018

Keep in Your White Coat:

  1. Something to read
  2. Sterile gauze (have at least 4)
  3. ABDs (abdominal pads)
  4. Tegaderm
  5. At least 1 suture removal kit
    1. Nonsterile scissors if you’re feeling fancy but you can just use the ones in the suture kit
  6. Tape
    1. Do not carry this on your stethoscope you look stupid and they judge you
  7. 3+ pens (keep a couple you don’t care about – your attending will borrow them and not give them back)
  8. At least 1 granola bar and I highly recommend almonds (Paige’s anti-pass-out trick of salt intake + long lasting energy!)

*a copy of your patient list in the back pocket of your scrubs so that you’ll have it right before and right after you leave the OR.

Things you don’t need: reflex hammer, penlight, your stethoscope after morning rounds unless you’re in clinic.

 

Anticipating:

  • in the OR
    • if they grab the razor to shave the patient, you grab the tape to remove the shaved hair
    • if they grab suture, you grab the suture scissors
      • do not use mets to cut suture – they will yell at you because it makes them dull
      • pull the finger holes of the scissors in opposite directions (up and down) to make a clean cut
        • leave long tails if: fishing wire-esque suture (plasticky), if it’s inside the body; if it’s on a biopsy specimen, if placing a JP drain
        • leave short fails if: silk ties, anything that is sutured in the epidermis
          • slide scissors down until you feel knot, then turn them and cut
        • if they grab a retractor, you grab the end and wait for them to let go cause they will not warn you and expect you to be holding tension already
      • on the floor
        • if anyone on your service needs a dressing change, figure out EXACTLY how it was done and have it changed before the residents round on that patient. Also remove all sterile dressings on post op day 2 (makes you look great it you do this before anyone asks you to)
          • If you’re not sure how it was done, ask. They get more pissed if you do it wrong than if you’re not sure and double check
        • If they’re waiting for lab values or CT results, compulsively check EPIC for them. If you’re the first one to notice, you get major points
        • If your patient went to get imaging done, be the one who knows when they get back to their room AND what the imaging study said.
          • Side note: when you write your SOAP note in the morning, include impression of any imaging studies taken since the previous night’s note was written. Your interpretation doesn’t have to be correct if the official read hasn’t come back yet, but it gets you points for trying.

 

Random Tips

  • When entering the OR area, you have to be wearing scrubs and a scrub cap (aka shower cap thing), and you cannot be wearing your white coat or a stethoscope. You don’t need to wear a face mask until you’re actually in one of the ORs, and you don’t need eye protection until you are starting to scrub into the case. Make sure you put your eye protection on and that your mask is comfortable before you scrub because once you do you are stuck like that for the rest of the surgery.
  • Med student jobs in the OR before and after surgery
    • Get your residents gloves. Learn their glove size and what order they like their gloves in, and have them ready
    • Offer to get the scrub nurse an extra gown because a lot of the time they won’t know a med student is coming in and it saves them from leaving the OR to get it, and they will love you
    • Wheel the patient’s bed in and out of the room quickly. Wheel it out as soon at the patient is seat belted onto the OR table, wheel it in as soon as everyone has unscrubbed (urges anesthesia to hurry the F up and wake the patient)
    • Write you and your residents names and years (we’re MS3, they’re PGY_) on the board
    • Do NOT back into the sterile table or you will literally get murdered by the scrub nurse. If you’re not sure how to unwrap the gloves and gowns in a sterile way, ask. It’s actually more complicated then you’d think.
  • During surgery
    • Be the first to scrub because:  1) Then your attending won’t yell at the way you are scrubbing, 2) It’ll take you longer to do everything and then you won’t be in the way when the scrub nurse has more important things to do then get you dressed, 3) You get to look a little less derpy
      • Alternatively, while your attending/residents are scrubbing is a great time to mysteriously disappear to go the bathroom/eat before the case starts
    • NEVER touch the mayo table (the little table the scrub nurses have all the crap on that hovers over the patient’s feet). Even if your attending has asked 6 times for something that is inches away from your hand, don’t get it for them. Don’t. Resist the urge.
    • Keep instruments and sponges from falling off the field. This includes: the bovie, the suction, lap pads and retractors. Everything else is the surgeons fault, but these things have long tubes or tend to get left on the patient’s feet and slip off
    • If you’re retracting, hold the retractor EXACTLY as it was handed to you. This means the same tension (don’t pull any harder than you have to), angle (‘toe in’ means pull the bottom of the retractor towards you to move a deep structure out of the way), and position (don’t let it slide along the incision site). Hold that thing until you are told not to, never relax without being asked to first.
      • caveat: some attendings will say ‘relax when I relax,’ but most do not feel that way
    • If they are boving up a storm and there is smoke everywhere, use the suction to suck it up by holding the suction tip close to the bovie without getting in the way.
    • If there isn’t a dry lap pad on the field at all times (exception: laproscopic surgery), feel free to ask for one nicely and when the scrub nurse isn’t already busy. It will be asked for eventually.
    • Ask questions, but only if the surgery is going well and isn’t at a stressful point. Never ask a question while an anastomosis is being made (these are stressful, someone will yell at you).
  • On the floor
    • If someone has a JP drain or an NG tube, make sure you look at the output. They will invariably ask the quantity of the output and what it looked like.
    • ASK EVERYONE AND THEIR MOTHER ABOUT FARTING AND POOPING. That is the most important question you can ask your patients – everyone is worried about small bowel obstructions and post-op ileus, and until they fart they can’t go home.
    • Know everyone’s post op day – if they have multiple surgeries (ie you took them for a colectomy but had to go back 2 days later for an ostomy revision), write both procedures’ post op days in your note
    • Talk to the nurses about overnight events – they will tell you things nobody else can, the residents often don’t bother to ask, and you look like a genius.
    • Offer to get people pillows and blankets to make them more comfortable. Never say ‘is there anything I can do for you to make you more comfortable’ because they invariably respond with: 1. I want water or 2. I want food because basically everyone is NPO.
    • Know what meds someone was on when they were at home – a lot of the time, the home meds don’t get restarted post-op, and you can have someone who looks like they have a PE, but you just forgot to restart their anxiety meds, or someone who’s tachycardic because they haven’t taken their beta blocker. Makes a HUGE difference in how spastic the team becomes in response to tachypnea and tachycardia
    • Each morning, check for any consults that saw your patient overnight, and be prepared to tell your resident what their recommendations are. If you can’t read it because their handwriting sucks, take a picture of the consult sheet and then when they’re like ‘how could you not read it’ you can show them.
  • Always eat, pee and take 2 advil before surgery. You have no idea when you will be able to sit down, pee or eat next.

 

Physical Exam Maneuvers

  • Cardio: listen to their heart
  • Respiratory: listen to their lungs
  • Abdominal: double check that they haven’t farted or pooped (ask the nurse cause senile patients will straight up lie to your face). Actually percuss (tympani in these people is insanely noticeable if they are obstructed), palpate and ask the patient if they feel bloated (distention is hard to tell between patients sometimes)
    • Listen for bowel sounds, but the surgeons really don’t care about them. Farting/pooping is more important
  • Check JP drain/ostomy bag output
    • If there is a tiny bit of clear-ish fluid in the ostomy bag, this is bowel sweat (yes that’s a real thing) and does not count as output
  • Check all incision sites. If everything looks great, write c/d/I (clean, dry, intact). Note any erythema, increased tenderness or warmth
  • Look for pitting edema on the lower extremities

 

Lab Values

Make sure you trend hemoglobin and potassium every day. They don’t really care about anything else.

They do not care about blood glucose. At all. Ever. It could be 260 and they wouldn’t care.

 

Frequently Asked Pimp Questions

  • Stages of shock (there are 4. Know them well)
  • SIRS/sepsis criteria
  • I had 3 different attendings ask me who Bovie and DeBakey were. Also randomly I was asked by 3 different (non-transplant) surgeons about who did the first kidney transplant (correct answer: a plastic surgeon)
  • Causes of small bowel obstruction in order of frequency (#1 adhesions, #2 hernia, #3 cancer)
  • 5Ws of post op fever
    • wind, water, wound, walking, whatever else = atelectasis/pneumonia, UTI, wound infection, DVT, a whole mess of random stuff
  • FRIENDS mnemonic for reasons a fistula won’t heal
    • Foreign body, radiation, infection/inflammation/IBD, epitheliazation, neoplasm, distal obstruction (high flow through fistula), steroids
  • Hinchey classification for diverticular disease – problem is that the list the residents learn is different from what the textbooks say. This is what the residents want to hear:
    • Purulent 2. Feculent 3. Mass near colon 4. Mass far from colon
  • Charcot triad, Beck triad
  • Everything about gallbladder disease – especially know when emergency surgery is needed, what kind of imaging to get and in what order, when you should put a percutaneous drain in, etc.
  • Know that primary survey for trauma (ABCDE)
  • Anything about pneumothorax/hemothorax (know everything about chest tube placement), pericardial tamponade (do an ultrasound as study of choice) and penetrating abdominal trauma (DPL/FAST exam, when to do an exlap, etc).
    • Massive hemothorax means chest tube drains 150 mL immediately or 100 mL/hour
  • For laproscopic surgeries, they infalte the abdomen with CO2
  • The cremaster muscle comes from the internal oblique, the nerves we are trying to avoid are the ilioinguinal, iliohypogastric and genitofemoral (favorite questions during hernia repairs)
  • “what was the patient’s pre-op hemoglobin?”
  • know the 421 rule for IV fluids, and what the difference between maintenance and resuscitation fluids are
  • if you’re in a breast surgery, know the boundaries of the breast and the blood supply
    • boundaries: lat dorsi, clavicle, sternum, inframammary fold
    • blood: thoracoacromial, lateral thoracic, intercostal, medial thoracic aka intramammary
  • treatment for hyperkalemia: C BIG K. I was asked this at least 6 times
    • calcium gluconate (fastest fix- stabilizes cell membranes), b agonists, insulin, glucose, kayexalate (chelates calcium in gut)
  • 4 mediastinal masses (4Ts: terartoma, thymoma, thyroid adenoma, terrible lymphoma)
  • common bile duct diameter normally is 4-6 mm
  • what is it called if you have a large stone in the gallbladder that intermittently obstructs the cycstic duct? Mirizzi syndrome
  • what is the first thing you do in someone with a suspected GI bleed? Place an NG tube.

 

Hope this helps!

Mr. Rogers Sr

Mark David Carey

Lewis Katz School of Medicine, Class of 2020

They quickly decide to name me. While I appreciate that they care to at least make an effort to humanize me, I find it slightly awkward, what with me being a corpse and what have you. Their name isn’t even close to my actual name, but I suppose that if I could adjust to a new home inside my white, plastic residence, then I can also accept a new name.

I quickly realize I have to temper my expectations upon my first encounter with the students. I nearly have my wrong side dissected the first day. I also lose one of my phrenic nerves almost immediately. At least I have another I suppose. Skilled surgeons they are not.

The fat which took me decades to accumulate is merely discarded or treated with disdain as they move through me, hunting for my more “valuable” features. At times I wish to apologize for obstructing what they wish to see or for resisting their efforts to flip me over. When dissecting my arms, they are surprised at how well developed my muscles are. They attribute this to the only thing they know about me other than my age and death:  my occupation as a mailman. I can’t help but feel a bit of pride for representing my profession well and for providing structures which they finally seem to hold in high regard. My pitch black lungs and rock hard liver appear to be sources of amusement and wonder for my new caretakers, as well as any visitors who stop by. They remind everyone that I was 92 when I passed, a fact that surprises most who care to inspect me. These prospective students appear to be an optimistic bunch, jumping to the assumption that my damaged organs were indicative of a life that was full of jolly times and lived to the fullest, rather than one of torment, despair, and frustration.

As we all begin to learn more about one another, the students become more relaxed with me. At times a comment of grim humor or a careless movement of my limbs gets under my skin, but overall these affronts are limited and they maintain the level of respect they first demonstrated to me. There are good days and bad days for us all. At times, the students spend most of their lab session simply digging through my fat to try and find an objective. At other times I wish to scream to them that the vessel or nerve of interest is right there… and then it’s gone. A careless cut with the scissors or tug of the forceps shreds my precious fibers. They’ll have to go look at that bastard two tables over.

As the end draws near for our time together, I find it harder and harder to keep myself together, namely because they have severed one of my legs and cut my head in half. I more closely resemble a Dali painting than someone who could once deliver an envelope and cuss at a yappy mutt. They are instructed to take a piece of my heart for further analysis and I hope that it serves them well. It amuses me how they seem to enjoy showing off my more well-dissected features. They readily adapt to casually discussing multi-syllable terminology.  I can follow along with some of it, depending on whether or not they discussed and defined it in my presence. At other times I am simply lost and confused by their discussions and phrasings. I wish to beseech them not to talk in front of patients in such ways when they one day care for the living.

Finally our stressful, reflective, and outright bizarre times come to an end. On the last day, hundreds of students crowd by me, desperately staring into my cavities, trying to determine what part of me their professors have decided to stick a pin into. I see the familiar faces of those who have greeted me each morning for the past eight weeks one final time. I like to think that I provided a calming presence for them in their stressful moment, two familiar halves of a face looking back at them like an old colleague of sorts. At last, I am zipped up one final time. I am proud to have provided help to those who also aspire to help strangers one day.

*Mr. Rogers Sr is the name Mark and his team created for their cadaver, since the donors remain anonymous

A Night in the Major Leagues

Madeline Lederer

Lewis Katz School of Medicine, Class of 2020

“Can you tell me where the CT reading room is?”

“I don’t know honey, try down there.”

“Hi, I’m trying to find the trauma team in CT”

“Oh, you’re with us”

“I found our first year!”

“Follow me.”

“Are you a Sox fan? I’m pretty loyal to the Phillies.”

“Just do what I do, and make sure the cords don’t catch on anything.”

“You missed some blood on the table.”

“We’re going to radiology.”

“Why did you activate trauma when her scans were negative?”

“You’ve only done anatomy?”

“We’re going through the list soon, try to follow along.”

“He’s crashing.”

“I’m going to get in line.”

“Do you know how to do compressions?”

“There were a lot of people, it’s okay, you’re only a first year.”

“Stay here, it’s more interesting.”

“Time of death, 8:24.”

“We get more and more delirious as the night goes on.”

“Follow me, we need to run the list.”

“I lost a good shirt, and a good bra!”

“The sound of those pagers gives me PTSD”

BEEP

“We need to go!”

“Put on gloves.”

“Should I take off my coat?”

“Do you know the trauma mnemonic?”

“Motorcycle crash, patient was not wearing a helmet.”

“Bilateral breath sounds normal.”

“Do you want any pain medicine sir?”

“Why is he shivering?”

“Someone call plastics.”

“I want everything scanned.”

“FAST is normal x8.”

“No Hemo, No Pneumo.”

“I refuse this treatment if you have to take out my piercings.”

“Are you on any drugs sir?”

“Take him to CT.”

“Don’t run with the beds!”

“You can never have too much Guac.”

“This is why he’s my soulmate.”

“Is this all going over your head?”

“I’m sorry it’s a boring night.”

“Transport, follow me now.”

“Sir can you hear me?”

“His right upper extremity is moving.”

“What time did he fall?”

“4pm.”

“What time is it now?”

“10:35”

“His wife gave him aspirin.”

“Subdural hematoma, subarachnoid hematoma, lacerated eye, possible stroke.”

“No Hemo, No Pneumo.”

“CT is busy.”

“Well tell them to make room!”

“Go get the blankets like I told you.”

“Great job!”

“We have no room.”

“Get this guy out now, his elbow can wait. Why are you even scanning his elbow?”

“Is his family here?”

“What artery is the most common cause of subdural hematoma?”

“Do you know what a pneumothorax is?”

“Where are we taking him?”

“I’m sorry Mr. Natale, this is going to hurt a little.”

“Quick pinch.”

“I guess we have to try again.”

“You’re lucky, you only get one try when they are awake.”

“Hand me a 4×4.”

“No, it’s up there, No! Up there!”

“Scuse me darlin’.”

“We are not taking him to the SICU.”

“I can’t sew him up, that’s muscle not skin.”

“I need to go update the family.”

“She’s a first year, of course she can’t read a ECG.”

“What mnemonics did I teach you today?”

“Food is here, let’s go.”

“You made it for the top of the ninth, sorry the Sox are losing.”

I walk out of the hospital at midnight more awake than when I arrived 5 hours ago and ride home in my scrubs, finally feeling like I am in medical school.

Thoughts in Anatomy

Peter T. Eisenhauer

Lewis Katz School of Medicine, Class of 2020

One day during anatomy, I was holding the hand and forearm of our cadaver, so that the arm was away from the body while my partners dissected the shoulder. The hand is different. Unlike the rest of the body, a dead hand feels very similar to the hand of a living person. As I stood there holding her hand, a rush of thoughts came over me. How many people before me had held this same hand? Did her grandchildren hold this hand on their way to the park? Did her husband hold this hand while she was dying? We are about to dissect this hand, after which it will no longer be a hand, but will only be tissue. Does this mean that I’ll be the last person to hold her hand? I notice my partners are cutting deeply into the arm in shoulder. It looks painful. I wonder if my hand holding is giving comfort to her. No – that’s silly. I snap out of it and think, “just forget about what you’re doing.”

Notes to a 1st Year

Written by the members of the Owl Wellness Liason group at the Lewis Katz School of Medicine at Temple University

“First year is a big adjustment, no matter if you came right out of college or have been out of school for 5 years. To help deal with the stress, make time to do something for yourself everyday. Whether it be exercising, watching a TV show, or another hobby, specifically schedule it in your day (and don’t just say you’ll do it when you get done your studying!)”

-Alex Pandelidis Class 2018, Marks College

“The best investment I made in med school was a pair of imaginary blinders.  Once you find a study strategy and daily routine that works for you, put on those blinders and just do your own thing.  I spent a lot of M1 needlessly worrying about how my study methods compared to those of my peers.  You’ll be a lot happier (and saner!) if you learn to just do you while in med school.

One of the best ways I learned to deal with the stressors of M1 was to keep in touch with friends and family OUTSIDE of med school.  Spending all day in MERB talking to your classmates about an upcoming exam can magnify your anxiety and give you a skewed perspective on life in general.  Whenever I felt myself getting trapped in the med school “bubble”, I would call a friend or relative to talk about things completely unrelated to rate-limiting enzymes and the histology of the male reproductive tract.  This helped me stay sane through the waves of stressful situations that I encountered throughout M1.”

-Peter Schartel Class of 2019, Babcock College

“My wellness advice for first year medical students would be to stay balanced and manage your time well. The administration really does their best to give you schedules ahead of time and accommodate requests made in advance. This allows you to continue to make time for the activities and people you love while honoring your academic commitments. Happy people make better doctors, so as difficult as it may be at times you need to make time for yourself!”

Kaitlin Healy, Class of 2018, Sherry College

“You know how they say med school is like drinking from a fire hose? Well I always saw it like you have to eat 5 pancakes per day, every day. 5 pancakes aren’t so bad right? Well two weeks in, you can’t eat pancakes anymore. The day after that, you have 10 pancakes to make up for the previous day. Now you have to skip your other meal to eat twice the amount of pancakes. And at this point you’re just completely sick of pancakes and can’t eat anything sweet.

Uhm, I think I got lost in that metaphor. Anyway, the material being thrown at you is completely manageable. If you let things build up, that’s when it gets overwhelming. Time management is the biggest key, and I wish I’d known that much earlier. Listen to what Alex said above. School gets its time, but you also get your time to destress, and both of those can remain priorities when you strike that balance with managing your time. My personal recommendation is to hit the gym every day, since it also helps burn off those pancakes!”

George GadOWLa, Class of 2019, Marks College

That’s Not Corn

Tory Toles

Lewis Katz School of Medicine, Class of 2019

There once was a girl who loved sushi.
She ate it every night for dinner.
Always thought raw fish was a winner.
Healthy, tasty, omega 3s galore.
But one day, she bought her sushi from another store. (She was too cheap to go to a real sushi restaurant.)
She ate three rolls like a champ.
But later that night, felt a cramp.
And then she saw a doctor and they were all “you have a diphyllobothrium latum tapeworm, it’s like the longest one out there,” and put her on meds so she could pass the segments for months.

The end.

spongebob-meme-fish-face-04

Photo Credit to the creators of Spongebob Squarepants