Taking a Breath: Real Patients, Real Medicine and Real Life

Yes, we have progressed from cardio to respiratory. Puns are not as lowly as you might think. They can even be witty. My gchat status has lately been alternating between "turbulent flow", "physiological dead space", "just dead space" and my latest one: "everybody needs a little TLC -that is "Total Lung Capacity"". I know. I am such a nerd (but you love me for it).

Anyway, this is a long post, so for your convenience, I have subtitles throughout so you can read only what you're interested in (and I'll save you the agonizing anticipation -there is no hot romance discussed below ;).

Cool stuff in the books.

So I'm learning about lungs, hemoglobin and partial pressures of CO2 and O2 lately. I won't bore you with any doc-talk (or med-student talk), but I will just briefly mention that respir actually does have a "really cool thing" analagous to the cardio "really cool thing" which was "Venous Return" (if you recollect). Basically, just like how the blood returning to the heart from the veins is one of the biggest determinants of blood circulation (rather than pure cardiac output), similarly, it is not low oxygen but high carbondioxide that decides whether or not someone is hyper- or hypo-ventilating (and other important things relating to breathing). It's always the counter-intuitive stuff that's coolest if you ask me. That is, counter-intuitive, but still understandable (unlike some of my lectures of late).

Brief meeting with 'Real Medicine'.

I recently had the following thought though: "Okay friends, med school was a fun adventure and I'm ready to go home now..." Except there is no home. This is home. And it is strange that the fact that this is my life and a lot more to come from now on, has only hit me now. Don't get me wrong, I am learning a lot, getting excited, getting bored, then excited again. I am still mainly starry-eyed about medicine -hopeful, momentarily discouraged, and then hopeful again. I pulled out my back, limped around for a week, and then healing and walking normally again, but during the limping around phase, I shadowed my former CEGEP orgo lab partner (who is now a Med-4) during his neurology clerkship. It was pretty awesome to visit patients with him, see a doc (well not technically I guess) actually do the reflex tests they always show them doing in kindergarten picture books, apply hand sanitizer 8 times in 20 minutes, do a little investigative work on uptodate.com, watch a "team" analyze CT scans of a stroke patient in radiology, and most excitingly: watching a real-live LP ("lumbar puncture" = spinal tap, the purpose of which was to test cerebrospinal fluid for encephalitis or menengitis) for the first time!

Keeping it 'Real': Life Pseudo-Outside the Med Bubble (okay, not really, but outside the book-worming bubble!)

This past weekend, I found out that I got the volunteer position I wanted with an organization in Montreal that advocates for public health care and immigrant rights, particularly fighting against a Quebec bi-law that denies healthcare coverage for newly-landed immigrants for the first 3 months. The organization -Project Genesis -also works with the local immigrant community providing various social services, advice (like helping find loop-holes in the law), etc. So I am looking forward to making my med school life actually mean something in the real world where the people live.

The noteworthy, traditionally heavily Med-1-attended Osler Banquet is coming up next week, and I have been involved in some small ways (like postering -Steiny and Chi, I finally know what your crazy postering lives were like -and some ticket distro next week right before). The guest lecturer is Richard Horton, editor-in-chief of the Lancet, who will be talking about doctors and their social responsibilities in a global health context. Should be pretty awesome. My Resp midterm is 2 days later.

Today I registered for MedGames, which is this:
Med students from across the country get together and compete in real sports like hockey, swimming and volleyball, as well as 'parasports' like DDR, Rock Band and Capture the Flag, and then 'bond' during various night-time social events. It is for a weekend in January, and every year is hosted by a different med school. Luckily for moi, the 2009 MedGames are being hosted by Universite de Montreal (UdeM), so it is just here at home, nice and cheap and convenient.

'Real Patient': First Official Clinical Encounter

I had my first official clinical encounter yesterday at the Royal Victoria Hospital, in our Osler Fellow's Hematology Department, a woman in her 40s with leukemia (sudden and acute -not the most optimistic prognosis) who was just about to have her first bone marrow stem cells transplant... what really struck me was a couple of things: firstly, she was super athletic and active and now suddenly has been bed-ridden in a hospital for 4 months. BUT it was so touching to see the amazing support system she has. 3 WHOLE WALLS COVERED in well-wishing, get well cards, family and friends by her side all the time (love was palpable in that room!). Also, the patient told such a wonderful story about how her brothers and sisters were all hoping that they could all be a match to donate their stem cells to her, literally "fighting over" who could give their dear sister their stem cells... and not only was 1 match found, but 2! Imagine finding 2 potential donors amongst sibilings of a stem cell recipient, when to find just 1 is a blessing. However, just as love was palpable in that room, so was the overwhelming sense of mortality, of feeling that life had been snatched away so quickly... imagine having to write your will when you're in your forties. That encounter will stay with me always I think. She is a beautiful person, and all medical reasoning aside, I will keep her in my prayers, my thoughts and my heart. I want her to be well. Too bad my wanting it that way alone cannot just make it be that way.

Right in the "Heart" of it: Cardio, Delicious Autumn Days

So, for the last 3 weeks, I have been learning all about the heart. Cardio is pretty awesome. Just had the midterm for it today -hopefully that went well. But I loved this first part of the second unit. I mean sure, it's just a pump -not a crazy, amorphous, mysterious brain or anything -but it is an amazing pump.

One of the coolest concepts, in my opinion, is the fact that venous return (which is the flow of blood from your veins back to your heart) is a stronger determinant of cardiac output (which is how much blood your heart pumps out and how fast) than almost any other factor. This is why if a patient has low blood pressure, giving them IV saline brings their blood pressure back up: you've increased blood volume in the veins, and thus increased venous return. Maybe this seems common-sensical to some of you, but I think it's amazing how learning about all this stuff teaches you to see medical "problems" and "solutions" in a completely different way. I mean, who would naturally think, "oh your heart is pumping too slowly/not hard enough, but if we give you fluid, we'll get it back up to normal". I'm telling you, these Frank-Starling people (the ones who said that cardiac output is equal to venous return, or put more simply, the heart will pump out what comes in)... geniuses.

Also, there are a ton of regulatory "reflexes" that we have, which really shows that our bodies are just really smart (most of the time). Like, why we don't faint everytime we stand up, or why atheletes have a lower heart rate than normal people, but this is okay, whereas if you're not an athlete and have a low heart rate, this could be very bad. Or what a heart murmur sounds like, and what it tells us, and when we should worry about it, and when it's okay. All those things we commonly "know", but don't really, really, really, fully, completely, understandingly know. And even the body's "stupidities" make sense, when you understand some of this crazy theory stuff (like venous return!) -I love medical school. And I am so happy that I am learning most of this for the first time now (rather than being "bored out of my tree", like some of the anatomy majors in my class).

This weekend is Canadian Thanksgiving. It is supposed to be a perfectly beautiful weekend and I am so excited for it -easy "hiking" at St. Bruno with my parents tomorrow, apple picking with some med school friends on Monday, catching up on sleep, movies, non-medical reading and writing. Even a couple of "chores". Met up with a dear friend after my midterm at this cute little place on Monkland, in N.D.G., called Gryphon D'Or. Tried it out a few weeks ago for high tea -Early Grey Cream tea, hot scones, Devon cream, lemon curd, fresh raspberry jam, cucumber and egg sandwiches, date squares, brownies, shortbread... delicious and non-pretentious -heavenly, really. So naturally, had to go back today, for Ginger Peach tea, scones, potato-leak soup and pleasant conversation. Today, I am in love with the world, the people in it, my city, and my life. I wish the same for you.