At the Buncombe County Health Department

Today I spent the day in the heart of Asheville, in western North Carolina, shadowing Dr. Mary Scott Hayes, a family practitioner at the Buncombe (pronounced "bunkum") County Health Department. She and her CNA assistant ran a pretty tight clinic, and the two exam rooms were kept occupied all day with a steady stream of patients.

The "Monday mornings"- that is, her more acute cases that called in for same-day scheduling, came first. Along with a gamut of migraines, belly aches, and mysterious viral fevers and coughs, we also saw a classic "disease and its complications" combo. A little girl with beautiful black braids came in with a fever and sore throat (but no sniffles or cough), classic strep symptoms. Sure enough, when we examined her more closely, she had the classic "sandpaper" rash (or should I say a fine, maculopapular erythematous rash) characteristic of strep, and white pustules on her tonsils (fun!). The diagnosis was confirmed with a strep test, and we sent her home with 10 days of antibiotics.

Later that morning, a young woman came in with a sore throat and fatigue. Her pain became more apparent when she could barely speak during the exam, much less say "ahhhh." She opened her mouth about a centimeter, and Dr. Hayes called me over, saying "I can't believe you're seeing this on your first day." The area surrounding her right tonsil was distended and red, blocking nearly half of the back of her throat. It was a peritonsillar abscess, a rare and extremely painful complication of strep infection. Unfortunately, this patient had "no payer," that is to say, she was uninsured, and getting an ear nose and throat doctor (ENT) to drain the abscess (which is a surgical procedure) would be complicated. Finally, she was referred to an ENT through "Project Access," the health department's organized way of distributing charity care for those in need. She was immediately sent over to the office for evaluation and (hopefully- fingers crossed) treatment. An abscess like hers could be fatal if not treated, so we're waiting to see how it all turned out.

Dr. Hayes spent the rest of the day marveling the fact that I saw these two cases back to back- I will never forget either!

Palpitations give me palpitations.

Monday was my first clinical exam, my first chance to show off my skills gathering a chief complaint, medical history, family history, and social and cultural history from an actor-patient, while being observed and recorded on camera by my preceptor.

Mr. Johnson presented with a feeling like his "heart was just going to jump out of" his chest. That's a pretty good description of palpitations, which is a tough symptom. Like chest pain, it can be so many different things- from anxiety to a life-threatening heart attack!

And what do I do? I proceed to go through the whole gamut of questions. Besides the medical and family histories, I also have to ask things like, "Do you consider yourself a spiritual person?" or "Are you sexually satisfied?" (I forgot to ask this one, BTW).

I know that these are all learning experiences, and one day it will be important to ask those questions, but sometimes it feels funny to move on from palpitations to spirituality, and then on to sexual satisfaction.

Post-Exam Ponderings

I had my first exam this morning, and my whole class celebrated this evening with Ben and Jerry's, complements of the UNC School of Medicine. Since I'm on a sugar high, I thought I would take a minute to reflect on some of the highlights of my first few weeks.

- Meeting all my well-spoken, outgoing classmates who are all so personable and have really unique perspectives on medicine and healthcare.
- Finding the perfect study spot at a local Caribou Coffee- in the window, by the corner. The wood paneling and moose decor just do it for me!
-Being picked up by a 20-year-old at the Carrboro DMV while waiting to take my driving test. And having him tell me I look his age. Yes!
-Taking a Latin aerobics class at the Student Recreation Center and watching about 100 other girls shake their booties to the "Gasolina" song. I know I shook mine!
-Interviewing my first patient, presenting with chest pain, and getting positive feedback from my group saying that I was genuine and empathetic. This stuff makes me know I'm going to be good at this- it feels like I was born to do it.

My schedule is pretty intense, but manageable. In the mornings from 8-12, we have our science courses as part of the Molecules to Cells block, and then one afternoon a week (Monday for me), we have Introduction to Clinical Medicine. Right now we're learning to do a complete medical, family, and social/cultural history on patients. Today an actor/patient came to class and we took turns interviewing him to interview him regarding his "cough that keeps getting worse." Later in the year we'll learn to do a physical exam, and this class will continue into next year to get us ready for year three, when we'll do our clinical rotations in hospitals, clinics, and doctors' offices. Most other afternoons I head to the library to study. Wednesday is a nice break for me because we have a Medicine and Society class, where we read essays and stories on the patient-doctor relationship, cultural and social issues of healthcare, and ethics and the healthcare system. It's completely discussion-based, and the assignments vary from doing a home visit for the preceptor's patient, to writing our own personal "illness narrative" that speaks to our concept of sickness, health, and medicine.

The first Block ("Molecules to Cells") ends on October 3rd, and we have a fall break the 4th and 5th. For all my DC peeps, I am planning on coming up to visit those days and the following weekend- let's hang! From October 8th-12th we have our first "community week." I will be shadowing a family practitioner in a public health department in Asheville, which is in way western North Carolina in the mountains (Appalachia). Should be beautiful. Our second block is called Structure and Development (anatomy, radiology, and embryology) and it starts October 15th and ends before Christmas break December 15th.

I feel like I have lost all traces of creativity; my brainpower is being used for other things. But I hope this starts to give you all a sense of my day to day. Here in medical school they always talk about the "take home message" for this or that lecture. The take home message here: I study. A lot. But I still have time to shake my booty while belting out "A mi me gusta la gasolina!"

One week down...

Well, here I am, survivor of the first week.



Already we tackled differential diagnosis of hemolytic vs. cholestatic jaundice, covered as much genetics in one week as in my summer entire biochemistry class, and learned all the points to cover in a new patient medical history.



The pace is brutal, but I'm managing to keep up, and no one really feels the pinch yet because our first exam isn't until August 27th.



I had my first CAMPOS (med school in Spanish) meeting, and we learned about the scheduled actvities for the year. We will meet just about every week to review Spanish medical vocabulary, issues of culture in caring for Latino patients, and eventually learning to conduct a full medical interview and exam in espanol.

...Signs of Life in Medical School

Welcome to my blog, my best effort at sharing with you the inside scoop on the first year of medical school. As the year goes on, when I'm up to my elbows in anatomy lab or banging my head against the wall trying to pick up the blasted heart murmur on my stethoscope, forgive me if I get a bit lax. Also, one disclaimer- many of you know and love my litte Luddite self, and hopefully you will forgive my lack of technical savvy. Let me know if I'm doing anything embarrasing like posting my bank statement or something.

On the first day of orientation, the Associate Dean of Student Affairs reminded the class that we didn't get to medical school alone. She went on to say that someone had to change your diaper for you to get here. For me it goes much further; I had the support of friends, family, and co-workers all through the pre-requisite classes, MCAT hell, and the tedious application process. In a way you've all taken those steps with me, and I am not sure it's fair that you aren't all here with me now to experience the best part, considering how much shoulder-lending, massage-giving, and venting-listening you did. I hope that I can share some of the "good stuff" with you as the year goes on. And I promise to make it PG, ie no detailed description of how we got to the spleen in anatomy lab.

The other thing that stuck with me from the past two days of orientation is a fourth year student who said, prefacing his statement with a "touchy feely" warning, "Medical school should not only be about becoming a better doctor, but also becoming a better human." I certainly hope that this will be true for me, and that I will be able to uphold the real reasons I came to school in the first place. In a way, I hope that this blog will hold me accountable to all of those who have gone before me and made the incredible priviledge to study medicine a reality for me, and to all those who I will one day have the honor of calling patients.

Two days and already on my to-do list: "become a better human." I guess they said it would be challenging!