Nerd Humo(u)r

Science journalism, from our cousins across the pond.

After reading one or two scientific papers in my day, and then reading how they were presented in the press, this left me chuckling.

The Big Chill

Cooling the body temperature of patients in cardiac arrest is becoming an increasingly popular method of reducing the damaged caused by a lack of oxygen. In the ER, I witnessed the adoption of a "code chill" protocol that involved an ICU team with a cooling unit for arresting patients.

According to this article, surgeons at Massachusetts General are preparing to employ a similar concept to trauma victims. By pumping cold saline through a patient's blood vessels, the team can lower body temperature to 10˚C, or a frigid 50˚F.

Claims the leader of the project, "By cooling rapidly in this fashion we can convert almost certain death into a 90 percent survival rate."

Pretty cool.

(Super) Bad Moon Rising

Uh oh.

Anyone up (say, studying anatomy) later tonight should be treated to a neat celestial show. For the first time in 20 years, the autumnal equinox is occurring on the same night as a full moon, an event known as a Super Harvest Moon.

For stargazers of all stripes, I'm sure this will be a rare and exciting experience.

For emergency medical workers, I'm sure this will be a long and bizarre night indeed.

Truths About Anatomy Lab

Scalpels are sharp. Speaking from experience, using a scalpel to dissect one's own flesh should be carefully avoided.

Also, my inner 10 year old wishes our cadaver was more like this:

Check out more images at Street Anatomy.

The Examinator

One of the more exciting, and often intimidating, elements of first year is discovering how to interview and examine patients. Practicing first on actors, my classmates and I will shortly dive (closely supervised, of course) into real clinical encounters to hone these time-honored skills on the genuine article.

As I anticipate listening to my first heart murmur and palpating my first abdomen, however, debate swirls over whether the exam is properly taught, and how relevant it remains amid increasingly digitized medicine.

NPR ran a piece yesterday examining the current state of health of the physical exam, which some physicians maintain is a cornerstone of the doctor-patient relationship. For a different perspective, Shadowfax over at Movin' Meat argues that the full exam provides little benefit over a careful interview and well-chosen tests.

Will the exam stage a comeback, or will diagnostic testing continue to play an increasingly important role? I'm sure the debate will continue. In the meantime, I have a brand new reflex hammer to try out...

Med School (As Told By Cliches)

It was the best of times, it was the worst of times.

Especially with all the information we are given; it's like drinking from a fire hose.

Sure my friends are making money and starting their careers, but the grass is always greener on the other side of the fence.

And remember, nothing worth doing is ever easy.

I mean, whatever doesn't kill you makes you stronger, right?

Someday, I'm sure, we'll all look back on this and laugh.

Occupational Hazard

In light of the recent shooting at Johns Hopkins, CNN.com ran a front page story about violence in hospitals, especially the ER. Citing a study from 2009, the article highlights that more than half of ER nurses had been spit on, scratched, pushed, or verbally assaulted on job.

A nurse quoted in the piece describes how her jaw was broken in an altercation with a patient who later explained that he "was tired of waiting."

One of the draws of emergency medicine, for me at least, is the ability and mission to treat anything that comes through the doors. Given the patient population, nobody who chooses to work in the emergency department should be surprised when the occasional punch is thrown - we often see people at their very worst, and it's part of the job.

But when violence inches towards the rule rather than the exception, that's a problem. As another ER nurse observed:

"You would never go into the supermarket and say, 'the tomatoes aren't good enough' and punch the clerk and get away with it. That's exactly what happens in emergency departments all over the U.S."

"Just" A Nurse

It never ceases to amaze me how often you'll hear someone refer to an RN as "just" a nurse. GuitarGirlRN's most recent post recounts a similar sentiment, namely that really "smart" nurses should have gone to medical school. When I hear statements like these, sadly even from some of my classmates, it makes me shake my head.

During my years as an ER tech, I worked primarily with the nursing staff, and developed mad respect for the profession.

As the saying goes, be nice to nurses. They keep doctors from accidentally killing you.

Truths About Anatomy Lab

1) Anatomy lab makes you hungry. People claim it's the fumes; I happen to try to remember structures by identifying what type of food they resemble, but either way, everyone leaves lab famished.

2) Anatomy lab makes you lose your appetite. Despite having a pretty iron-clad stomach, nothing really induces nausea like swallowing a big gulp of formaldehyde and phenol while leaning your head into an empty thorax in a vain attempt to find yet another vein.

3) Anatomy lab is delicate. It only took a few attempts at scissor spreading fascia or trying to dig out a tiny vessel to confirm that I will never become a surgeon.

4) Anatomy lab is barbaric. Two words: bone saw.

5) Anatomy lab is terrible. You spend hours of your afternoon in a windowless dungeon trying to memorize an unfathomable list of terms while digging out never-ending globules of fat, only to realize that the tiny structure you're looking for is buried in fat. The fat you just ripped out.

6) Anatomy lab is incredible. In all seriousness, it truly is a privileged insight into the awe-inspiring complexity and beauty of the human body. Add the fact that a person made the choice to donate their body to further our medical education, and this rite of passage becomes all the more humbling.

*The image comes from Street Anatomy. Check it out.

**This post was written during time I should have spent studying anatomy.

The Circle of Life

One of the biggest changes I've noticed so far between college and medical school is Block-based scheduling. In undergrad, you'd have an exam or two throughout the semester, and then one massive final to worry about at the end. In med school, we're tested every three or four weeks. While we're currently only in the midst of Block 2, I've already noticed some cyclical trends, especially in terms of the weekends.

First Weekend:

We've barely covered anything this week, and we have so much time before the next exam. Hakuna Matata!

Second Weekend:

Wait... I have to learn the entire citric acid cycle again? Um, where did I put that biochem book?

Third Weekend:

Don't sneeze so loudly, this is a library! I have 800 more flashcards to memorize!

Fourth Weekend:

Post exam bliss. That wasn't so bad, right?

Just rinse and repeat for the next two years.

More Data on ER Overcrowding

Several news outlets have picked up on a new study from Health Affairs that details how emergency departments continue to replace private physicians as the source of acute care in the US. Decreasing access to primary care drives up visits to the ED, leading to longer waits, overcrowded departments, and higher cost. Read more about the study here and here.

"The Sun. It is Making Much Warmness Today!"

From the same comic genius that brought us a far more descriptive pain scale*, comes The Four Levels of Social Entrapment. I highly recommend you check it out.

Even after orientation, those first opening weeks of medical school saw the same conversation (Hi! What's your name? Where are you from? Where did you do your undergrad?) repeated ad nauseum, often with the same person. By this point, much of the initial awkwardness has subsided, though I'm embarrassed to say there are still several classmates whose name I do not know.

I wish I could claim these are people I haven't yet managed to meet. But no. While I'm great with faces, I'm terrible with names, so there is a distinct population of students who greet me with a chipper "Hi Second Shift!" each morning before class, only to receive a tentative "Hey...you..." in reply.

Since we're beyond point where it is socially acceptable to ask someone's name, I think I'm just going to have fudge it for the next four years.

*In case you need proof of hilarity:

Scale ranges from "I am completely unsure whether I am experiencing pain or itching or maybe I just have a bad taste in my mouth" to "You probably have Ebola."

I'm Not a Med Student, But I Play One On TV

"Oh, you'll see him again for the male genital exam."

So explained my Clinical Skills mentor after one of my classmates finished interviewing her standardized patient. SPs - actors paid to present with a particular history and illness meant for us to uncover - are the wading pool in which we dip our toes before interviewing (and yes, examining) real, honest-to-goodness patients in just a few short weeks.

When I worked in the ER, I had few problems establishing a good rapport and asking questions of my patients. SPs are a little different. Maybe the video camera and 12 other people watching the interview have something to do with it, but more likely is the fact that we're asking questions and obtaining information without any idea how to act on it. I know that will come in time, but for the moment it feels like we're acting just as much, if not more, than the SPs.

I suppose you could say that we're learning the importance of projecting confidence, of affecting the right demeanor with open body language and maintaining eye contact.

Put another way, the motto could be "fake it 'til you make it."