Medical school offers a lot of unique experiences, a lot of them are amazing some are frustrating (studying and feeling like you haven’t made progress, something we all go through). But, so far it’s pretty rewarding. To give you an idea of how my life now works, here’s a write up of one of my days.
I wake up about about 6:30 AM (just to clarify, I’m absolutely not a morning person). I must be sure to arrive at school by 7:45 AM if I plan on filling my coffee mug, and having my keister in the lecture hall by 8 AM. My school offers complimentary coffee if you know where to find it. I tried, with moderate success, to preview the slides for the day of Gross Anatomy lecture and prep for another anatomy dissection for the afternoon. The anatomy lecture lasts for a few hours, we covered the back, spine, shoulder, upper arms, and forearms in the last couple of weeks. We are responsible for knowing muscles and their: actions, origins, insertions, innervations, vasculature and the infamous brachial plexus — I should also mention that we’re also responsible for knowing the bones on our own, we’re assigned a “bone box” with an assortment of bones to self study as on our own time. On that particular day, we were on the forearm and the muscles of the hand, this also included common fractures such as the Colle’s fracture and the Boxer’s fracture. The former fracture common to athletes like football players who fall with a flexed wrist, where their distal radius breaks at the styloid process and/or ‘simply’ stops making contacting with the collective wrist bones. The latter fracture is somewhat of a misnomer, it’s a fracture of the 5th or so digit (pinky) usually seen in people who were fighting, it’s a misnomer because an actual trained boxer probably knows how to punch someone without fracturing their fingers in the first place. At noon I devour lunch with my classmates, and typically mentally brace for dissection lab. On that day, we were the second team to work so we had free time to study before going in to finish the rest of the planned dissection — the dissection went well for both teams.
Overall, the tricky part about anatomy is figuring out how to squeeze it all in your head in a meaningful way. Our medical school tries to emulate Step 1 by giving 2nd or 3rd order questions, i.e. a clinical vignette wherein we have to both figure out what the question is asking and answer the question (long story short, they’ll never ask you a straight forward question). Lab is a tricky challenge, as you not only have to prepare for lab for yourself but also for your team; the worse you perform the worse your teams performs. For the first couple of weeks I was pretty stick from the formaldehyde, I’ve always had asthma so it really got to me. But, I just kept going into lab to grow accustomed to it, once a lot of the fat was removed the smell dissipates a bit, so things are better — though, I expect the allergies to come back once we dice into the viscera. I ended up finishing the day at about 5 PM, as we stayed a little longer to make sure we’d be on track for Wednesday dissection.
After finishing dissection, I had to change from my stinky scrubs to clean scrubs because I was to shadow in the trauma unit at 6 PM that evening. I didn’t bring enough food, so I had to engulf more food from a local Subway, then rush back to the hospital (fortunately, there’s a lot of food options close by). I went to the main desk of the hospital and picked up the phone to page my resident, someone came and we hung out in the trauma waiting room where the doctors wait to be paged. That night, I was on with trauma consult, this means that patients come in with bad conditions that may require surgery and they have to be delegated out to other departments (ortho, general surgery, etc). That day, my resident assumed it’d be slow in comparison to the weekend, where people have a penchant for getting injured the most.
It did certainly start off slow, we even had enough time to grab a coffee and the resident gave me advice on residency. The only case we had to worry about was an elderly person who had fallen and had fractured their hip, this fracture didn’t come up on X-ray weeks before and had shown up on a CAT scan when they came in with complaints of not being able to ambulate.
Then, that all changed when suddenly all the available trauma bays were full.
A young women who was injured by a car with severe bilateral hip dislocations and multiple fractures, they was wearing a neck brace because they weren’t sure if they also suffered spinal injuries. As you may have imagined, they was extreme pain with intermittent and understandably bawling and screaming that they couldn’t feel their legs, their ankles were twisted, and there was random spats of blood in the trauma bay. A sheet was tightly tied to their hip to keep everything in place. X-ray techs used the portable X-ray to get an idea of how bad it was, we later went back to the trauma waiting room to view the images on computer, it was terrible and they’d require decompression (aligning the bones back in place) by a team of ortho surgeons. The good news is that they didn’t have pneuothorax, but there was a question of if air had entered their viscera and was internally bleeding as one would expect with such a horrible accident. The initial CAT scan argued against this, however, the images was sent up to a team of radiologists in the hospital just to follow up.
While this was all happening we’d jump back and forth between the trauma bays to attend to two motorcyclists who were struck by a car. The driver, had a Colle’s fracture and a huge hematoma on the sternum where presumably the handle bar had blowed into the chest; it was also likely that their had a fractured hip. The passenger was ejected, flying over him onto the too of the car, they also had injuries. Glancing at the monitors we could see that, despite their injuries, they were hemodynamically stable and just in an extreme amount of pain. The drive couldn’t remember the accident, so they were sent up for a CT scan to ensure their head was okay.
While we were waiting for the CT scan, they resident asked me to go get histories on the female who was dragged under the car. We have a class called Introduction to Clinical Medicine, here we practiced taking histories; not that I thought I’d be using it so quickly. Now on pain medications, but still obviously in discomfort I approached them, asked their name and took their history and jetted back to my resident to report. Apparently satisfied, the resident asked me to go find the motorcyclist getting a CT and get the drivers history as well. Hospitals aren’t the easiest to navigate, and I probably looked like a lost puppy, but I did eventually find him and got his history as well. Then I had to track down the resident and their attending and report the history so they could document it, no one was upset so it must have worked out.
The beeper went off yet again, this time an inmate had tried to unsuccessfully suicide attempt. We bypassed the two guards, to approach our shackled patient in bed lying in wait for medical attention. This person had several contusions on their forehead, as earlier that day they were banging their head against the wall and several more bruises on their neck where the sheet they used to try to hang themselves had caught. We got the history this time together, their complained of pain and complained of blurry vision. The blurry vision worried the resident, the guard sitting in my view then made the universal binocular hand gesture, so I blurted out “Do you wear glasses?”, and they said “Yes”. This person was also on a slew of psych medications, and probably needed social work more than medial attention (I hope they get it), having worked with inmates previously I really feel for the spiral of events that may of lead them to here.
We then rushed up with the attending to go talk to radiology about their patient who was currently in surgery to decompress one patients hip. The attending there spotted some air in their viscera, and so surgery was paged immediately and one attending went to go update to let ortho know that they’d have to watch for internal bleeding.
Soon, the resident then said, “Remember that women with the infection? Can you go get a history from them?”. I had forgot about that woman, just like how I forgot to mention their in this story because the whole night was a blur. This patient had hurt their foot, and had come in with severe swelling of their foot. But, after interviewing them we learned that their now infected foot was accompanied by pain deep under their knee (DVT?). I reported back to my resident, noted the pain and we spoke of the possible DVT (this they was already watching for) and the new symptom polyuria that coincided with the infection before they came in.
By the time we had done all of this, it was now 10 PM. The gentleman and the passenger on the motorcycle were both stable, and hanging out in the ER for observation. The women who was drug under the car had their hips set back in place, and would be ready for follow up surgeries later, by the way they could move their toes so they were lucky to escape serious nerve damage. My shift was over, I was invited back for more by the residents and I shuffled out of there and rode the train home being too tired and lazy to change out of my scrubs, took a shower and woke up at 6:30 AM to start another day.
Disclaimer: certain information was changed in the story to protect patient and physician privacy.