Macro to Micro and back again

Yes I am still alive, although the last several weeks have been intense for several reasons. First, I have caught a nasty cold, and after coughing for three weeks, I figured it was time to embrace allopathic medicine (that thing that I am studying – the type of medicine that fixes disease with drugs and/or surgery). So I have started to take some antibiotics, and some great narcotic cough medicine that helps me sleep. Sorry to all of my natural minded friends for disappointing you, but I deluged my body with airborne, vitamin c, multi-vitamins, zinc, echinacea, and goldenseal…..all to no avail. Seems this little virus or bacteria is stronger than my immune system. Go figure, since stress decreases immunity! Again, one of those painfully ironic truisms about medical school: the process of learning about health and disease leads to poor health and disease in the students!

In addition to this darn cold (cough, cough, cough), we have had three exams in three weeks. Which means three weekends in a row of constant studying (including this one). No wonder I haven’t written anything! First, we had our final in anatomy (all the head and neck structures – SO glad to be done with that), then our first clinical/patient exam, and in a few days, our first exam in histology (the study of cells, tissues, and organs).

I am just as enthralled with microscopic cells as I was with Larry’s muscles. We study the different cell types – muscle, nervous, skin, connective, and then go to the lab and look at them under the microscope. Do you know that there are more than 200 different cell types in our bodies? Each with a specific job to do. What amazes me the most is that during development in the embryo each cell only reads a certain portion of the DNA, to become a certain type of cell, even though every cell has ALL the information encoded in the DNA. How then does a cell know what to become? One of the mysteries of science that has yet to be discovered, and that makes me believe in some sort of divine force imbuing everything.

In the middle of learning about all these fantastic cell types we had our first GOSCE exam. (Can’t remember what GOSCE stands for, but basically it is a practical exam where you go into a room and “treat” a patient). We all had a team of colleagues (four other students) that we could confer with for two minutes and then we had to enter the room and take care of a patient. Here was my test:

“You are on duty in the Emergency Room.

A 46-year old woman, Susan Finch, has just presented with multiple contusions and lacerations on her face and forearms. Upon questioning, the patient explained that her injuries were sustained in a fall down a long flight of stairs. She was bleeding quite profusely from one long cut on her cheek. You cleaned the wounds and were just finishing up the stitches when your nurse called you out of the room. In the hall you review the patient’s file which wasn’t available when she first arrived and needed immediate attention. It reveals four previous emergency room or clinic visits for similar injuries sustained during household accidents in the past two years. One of these took place only two months ago. The patient has been escorted to a private room available adjoining the ER. Enter the room and obtain a more complete history before releasing the patient.”

Somehow I knew that I was going to get the Domestic Violence patient. It was the one that most students were afraid to get. We are comfortable with taking blood pressures, listening to heart and lung sounds, or testing joints, but when it comes to these psychosocial issues, well, let’s just say that there’s nothing easy about looking at someone with a bloody bandage on her face (which the actor really had). I had seven minutes to talk to this patient, and find out her story. Once I determined that she was being beaten, the rest of the interview was….well, kind of easy. Easy to reach out in empathy, easy to tell her how concerned I was about her health, and the impact this abuse was probably having on the children in her household. I didn’t even notice the instructor/doctor grading me. It came naturally to show concern, and to give her advice about what to do next. Despite the questions that I forgot to ask her (was supposed to ask her if she was pregnant, and if drugs/alcohol was involved at all), I felt confident about my performance, and the patient told me that she could tell I really cared about her.

I really enjoyed this exam because it was the first one that reminded me why I am really here: To learn how to take care of people. From the macroscopic to the microscopic anatomy, and then back again to the big picture. Like the cells that have some force directing their development, I too have a divine force coursing through me, leading me to say the right thing to a victim of domestic violence. How did I know what to say? That, like the cell’s differentiation, is a mystery that doesn’t need to be understood, just embraced.

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