Week 4: The Control Room

          When the doors to the standardized patient lab opened, I was stunned by the intricacy of its setup. Modeled just like a typical medical office, with a receptionist desk, waiting room, and eight examination rooms, one would likely be fooled by its real purpose. As a group, my classmates and I were given about fifteen minutes to explore the patient lab, the setting in which we will all be tested next Friday. Let me fill you in on what I know so far…

          So what’s a standardized patient lab? Imagine your typical medical examination room, with an examination table, a blood pressure cuff and otoscope hanging on the wall, a scale…etc. Now, just add a couple of video cameras to each of the four walls of the examination room, and you’ve got yourself a standardized patient lab. Next week, I’ll be tested for my Behavioral Medicine class within this patient lab. The PA program hires trained medical patient actors and actresses who literally act as each of our patients for 15-20 minutes. The actor/actress is scheduled for a routine physical exam, and that is the extent of what we have been told. We have been instructed to learn how to take a complete patient history by next Friday. We have also been told to become experts on ovarian and breast cancers, specifically on their pattern of inheritance. I highly suspect that I will be breaking bad news to my ‘patient’ next week, and so it is very important that I am well-informed on the topic. As we take the histories of our patients and subsequently break the difficult news, we are being watched by the professors. One room in the standardized patient lab is reserved for the professors. I like to refer to it as the control room. In this room is a large computer displaying 4 x 4 inch screens of each patient examination room. So, everything I say, every action and movement I make, will be seen by the professors (a bit scary). I have heard some interesting stories from second year students about this experience, so next week’s blog should be fun to write.

          The workload piled high this week, but I am still keeping up with the material. Unlike in my undergraduate studies, now I never feel like I have studied enough before going into an exam. At this level of speed, it is no longer possible to focus on the discrete details of everything; it’s more important to understand the broader concepts (for some classes at least). The good news is that my body has officially adapted to awakening before the crack of dawn. Yesterday I naturally woke up at 4:50 am—10 minutes before my alarm, so I am very proud of that (though I will undoubtedly be sleeping a bit later the next few mornings, so that may mess things up a bit). This week in HEENT we learned how to differentiate between benign and malignant neck masses, in addition to determining the source of an inflamed lymph node. In dermatology we learned how to diagnose and treat various forms of acne, and disorders of the hair, nails, and outer/inner mouth. Summer (the cadaver) is doing well. The two days of dissection this week were spent studying the outer and inner structures of her heart (Summer’s heart was, by far, the largest in the class). We will spend the next couple of weeks dissecting her abdomen. Then, believe it or not, it’s already midterm time!

Question of the week: The left heart valve (also called the bicuspid or left atrioventricular valve) is also referred to as the _________ valve.

Last week’s answer: A cholecystectomy is the surgical removal of a gallbladder.

Week 3: Two Lungs And A Heart

          With a firm grip and a bit of pressure, I cut though the sides of Summer’s (the cadaver) first four, left ribs. I then passed what resembled gardening shears to the adjacent member of my lab group. The shears circled the table until all twenty-four of Summer’s ribs had been cut. As one opens the flaps a gift box on his or her birthday, eagerly anticipating the contents within, we all grabbed a portion of Summer’s rib cage and lifted it away from her body. And there they were—arguably the most vital organs that once sustained Summer’s life for at least seventy years—two lungs and a heart.

          Yesterday’s lab was definitely one of the more involved dissections, at least thus far into the semester. Sure, you can be as forceful and messy as is necessary to break through bones (like the ribs), but once you start exposing delicate vessels and nerves, one wrong slice with your scalpel and you’ve mistakenly cut through a very important structure. We’ve been assured many times that we get plenty of practice before we are thrust into our surgery clerkship, so that’s a good thing! Also, you can study as many diagrams and pictures in textbooks as you want, but arteries, veins, and nerves in a real human body are unfortunately not color-coded and as easily distinguishable. For a while, the thin, elastic tube you have wound around your scalpel doesn’t seem so significant until you take the time to identify it. This week we focused more on chest musculature and lung tissue. We were able to remove both lungs, which were incredibly spongy in texture. A few other lab groups opened their rib cages to find that their cadavers were presumably heavy smokers–these lungs, not so spongy (as you can imagine) and very darkly colored. Next week we open our next ‘package,’ that being the thin, protective membrane (pericardium) that encapsulates the heart.

          My other classes went well this week. Behavioral medicine focused on motivational interviewing of patients, specifically encouraging patients to lose weight or quit harmful addictions. We also learned how to effectively take our patients’ social and sexual histories (not an easy task until you know the best methods). HEENT focused on diagnosing and treating disorders of the mouth and throat, and Dermatology focused on diagnosing and treating eczema and other allergic reactions that manifest on the skin. Overall, this week was a very busy, but productive one. I definitely have a hefty amount of information to learn over the next three days ‘off.’

Question of the week: A cholecystectomy is the surgical removal of which body organ?

Last week’s answer: The systems of the body are: Integumentary (skin), Skeletal, Muscular, Nervous, Endocrine, Cardiovascular, Lymphatic/Immune, Respiratory, Digestive, Urinary, and Reproductive. 

Week 2: No Job For A Scalpel

          It has been merely two weeks, and I can confidently say that I have never learned so much new information before in such a short amount of time. Keeping up with (and staying ahead of) the coursework at the speed with which it is being taught is a challenge…but, so far so good.  

          Five new classes began this week, including Clinical Anatomy, Physiology, and Behavioral Medicine. Behavioral Medicine seems like it will be a very interesting course. It focuses on how to foster effective, professional clinician-patient relationships through proper communication skills. The professors pair us off, one student plays the role of a PA and the other plays the role of a patient. This week, we learned how to manage the patient who has been sitting over an hour in the waiting room, the patient who is confident that he or she needs an antibiotic prescribed, though he or she actually does not, and a patient who refuses to be treated by a young clinician. Trust me, this is not as easy as it seems. I hear very interesting things about our midterm and final for this class, so stay tuned for those stories!

          Thus far, in HEENT, we have learned how to diagnose and treat headaches (both mild and severe), as well as disorders of the nose and sinuses. The past two weeks of Dermatology focused on the recognition, diagnosis, and treatment of benign and malignant skin lesions, as well as diagnosing and treating infectious diseases of the skin (bacterial, fungal, and viral).

          Of course, I will never leave out a Summer (the cadaver) update. Tuesday, we excised her back skin, exposing most of the surface back muscles. Yesterday, we removed these same surface back muscles to expose deeper muscles of the back and neck, and then removed the back of her spine (a laminectomy, in fancy terms) to expose her spinal cord. The laminectomy was no job for a scalpel. We had to take a chisel and hammer to Summer’s back to break the bones (vertebrae) surrounding the spinal cord. Yes, it was a loud and messy job, but an amazing experience.

Question of the week: There are 11 recognized organ systems of the human body. How many organ systems can you name?

Last week’s answer: The smallest bones of the human body are located in the ears (the malleus, incus, and stapes).

Week 1: The Cadaver

          I rolled out of bed at 5:00 a.m. Thursday morning, donned my scrubs, and fled to school, eager to meet my first patient whose appointment was scheduled for 7:00 a.m. At 6:50 a.m., I and 53 of my other classmates opened the doors to the cadaver lab. At least 40 metal tables filled the room, all neatly arranged and equally spaced. Atop the tables rested long, white bags, zipped to conceal the contents within. Divided into six groups of 8-10 students, we were all assigned one of six tables to stand beside. I stood in place, listening carefully to the instructions being given, my eyes, all the time, fixed on the bag in front of me. After about twenty minutes of patiently waiting, we were instructed to unzip the bag, and it was then when we all met our first patients.

          I have dissected many animals—insects, sharks, lizards, frogs, cats, pigs (to name a few)…but never a human. The cadaver that rested before me once had a life, a family, and so I was definitely hesitant, at first, to begin examining its body. But, once the bag was removed, I inspected the cadaver, an older-aged female, likely in her mid-70s (with a fresh manicure, might I add). We were then instructed to perform a head to toe examination of her. Every cadaver used in the lab passed of natural causes, and so by the completion of the dissection, 14 weeks from now, it is our job as a group to present three most likely causes of our cadaver’s death. I was amazed by how much information we were able to gather by simply inspecting her outer body. My group established a few hypotheses on the likely cause of death, but confirmation will come in the upcoming weeks (hopefully!).

          After about an hour of examining our patients, the professors required that each group name their patient, at which time we chose the name Summer. At last, the cadaver was no longer an ‘it,’ no longer just an object to prod at and dissect, but rather an individual, with a new identity, who would begin to serve such an important educational purpose. I have only been provided this once in a lifetime experience because of Summer’s courageousness and willingness to donate her body to science, and so I see it fitting to dedicate all of the knowledge I acquire throughout the course of this dissection to her.

Question of the week: Where are the smallest bones of the human body located?

Last week’s answer: The heaviest organ of the human body, by weight, is the skin, also called the integument.