The Excitable Scientist

Mostly cheerful, sometimes snarky commentary on life science research and its broader impacts

Thank U April 28, 2017

Filed under: clerkship,medschool — excitablescientist @ 8:54 pm
  • To my roommates, who have been there for me more than I have for them,
  • To my love, for imbuing this year with joy and meaning,
  • To my fam, who I suspect don’t entirely understand why I never seem to have time to talk to them but love me anyway,
  • To my friend who I visited in paradise on a weekend whim, in what was possibly the most sanity-preserving decision I made this year,
  • To friends who have sent postcards, texts, Skype calls to remind me there’s a world beyond call rooms and pagers,
  • To all friends I cried to on the phone,
  • To all friends I cried with in person,
  • To everyone who’s ever brought in snacks to night shifts in the ER, you people are angels (whoever brought in the homemade spinach dip, I’m looking at you especially!)
  • To everyone who treated me as a valued member of their team,
  • To every patient:

Thanks.

Wreck Beach

So long, clerkship. 

 

Clerkship: like chugging Gatorade on a hot summer’s day June 28, 2016

Filed under: clerkship,medschool — excitablescientist @ 9:58 pm

I wanted to write down some thoughts on clerkship at the end of my first week of Pediatrics, but, well I was on call 3 nights in 7 days and had a busy social schedule thereafter (that’s right! I have a social life! Probably more so than I had before clerkship to be honest, because I’m a lot more aggressively prioritizing it. I have plans almost every evening that I’m not on call.) I mostly wanted to write down what surprised me, and now I’m worried that I’ve already started to take things for granted that were totally new just a few weeks ago…

 

They say learning in medicine is like drinking from a fire hose. I say clerkship is like chugging Gatorade on a hot summer’s day when you’re thirsty during a strenuous bike ride. It’s kinda overwhelming because your heart’s pumping and some degree of spillage is inevitable, but you also kinda want to look like you can handle it in front of the people (or person) you’re with even though you can’t really. But most of all, the sugar and electrolytes and water replace what you don’t even realize you’ve been missing, and they produce pleasing sensations in your mouth and tummy and provide positive reinforcement for what you’ve been doing and help propel you forward. Anyway, I love it (clerkship), so far, almost as much as I love bike trips and mixing metaphors.

 

On my first day I felt like a deer in the headlights, like I literally didn’t know anything. What is a patient chart? What does it mean to be admitted to hospital? What’s rounding (is that how your body changes in response to sleep deprivation and consequent calorie overload?) What does it mean to be on call? And when should I wear scrubs and why do doctors wear them outside the hospitals–do they just really love spreading germs around? So I’m going to try to explain some of these concepts, because we’re not really taught them in the pre-clerkship years (because we’re too busy learning e.g. that the dentatorubrothalamic tract travels in the superior cerebellar peduncle; oh B&B, I’m still bitter!)

 

Patient chart – OK, this one’s pretty simple; at the hospital I’m at, it’s a binder containing all the information pertaining to the patient’s current hospital admission. Including a detailed history (what brought them to hospital), progress notes (have their vital signs been stable? have they had any difficulty breathing/eating/pooping/urinating etc? do they have any other complaints?), lab results etc. The tricky part sometimes is figuring out what information to file under what tab, and this can vary depending on what the patient was admitted for. For example, someone with an eating disorder has slightly different charts that are filled out compared to someone with kidney disease, and the infants in the neonatal intensive care unit have different charts compared to those same infants when they move to the pediatrics ward. At LGH, there are different tabs for physician’s notes and progress notes; progress notes are written by nurses, who generally check on their patients every few hours, whereas physician’s notes are written by doctors and medical students after morning rounds and if there are significant changes to the patient’s condition.

 

Rounding – This one I still don’t quite get, to be honest. So far my understanding is that after coming to the hospital in the morning (8am start where I’m at), we look at the charts for the patients admitted by pediatricians on our ward to see what happened overnight… was the patient stable, do they have any new symptoms etc. After reviewing the chart, we’ll go talk to the patient, ask some targeted questions and perform a focused physical exam to get an idea of how they’re doing today. Then we’ll go write up a note about what we did, signing with our name and MSI3 (stands for medical student intern, year 3). I think the idea also is to come up with a plan for the patient with our attending doctor – investigations, medications, consultations, plans for discharge, and include that in the progress note, but I haven’t done much of that yet.

 

Now for the softer stuff… for inpatient Peds I’ve been at Lions Gate Hospital on the beautiful North Shore and it’s been swell. I’m here on Peds with one other medical student, and he’s a fantastic colleague. The call rooms are plush but have no windows; I find them too dark at night and have an incredibly difficult time waking up in the morning, to the point where I’ve considered sleeping in the resident lounge instead – yay natural light! I’m still trying to figure out the food thing… Week 1 was amazing, I brought all my food from home, but was also carrying around like 7 Tupperwares… not exactly the pinnacle of elegance (not that that’s ever been my strong suit). Week 2, things started to slightly fall off the rails… and now it’s Week 3 and I’ve only been eating cafeteria food – which is actually great but expensive – and takeout. Lots of plastic waste, more animal products than I would consider ideal… I need to get back on track with preparing food, but it’s hard and I’ve been prioritizing spending time with friends, sleep and getting exercise over eating healthy. Can’t win ’em all, at least not at the same time.

 

I have this new policy where I don’t check Facebook (not Facebook Messenger, just Facebook the app where I get to fuel my narcissism and feel inadequate relative to other people simultaneously) at all while on hospital grounds. I was surprised by how much that’s helped me be less anxious and more productive, and some days I even feel like I can handle adulting (that doesn’t last very long). I still check Twitter on my breaks, but I find the ratio of news to humblebragging to overly flattering selfies much more favourable.

 

So to sum up, so far inpatient Peds has treated me fantastic, and I’m sad it’s going to be over so soon. As a hopeful family doctor to be, I can count on two hands the number of weeks of training I have left in any one discipline, such as Peds, so I’m trying to make the most of this very limited and special time. As Annie Dillard writes… “We have less time than we knew and that time buoyant, and cloven, lucent, and missile, and wild.”

 

In future posts, I’ll also explain being on call, hospital admissions, the scrub thing, what a consult is, who an “attending” is and why we’re using an adjective that sounds like a verb as a noun, inpatient vs. outpatient rotations… and probably more. I’d love to hear if anyone finds any of this remotely interesting or useful (or not!), so leave a comment below…

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Riding the train through northern Puget Sound, likely not far from where Annie Dillard wrote Holy the Firm. “We have less time than we knew and that time buoyant, and cloven, lucent, and missile, and wild.”

 

 

looking forward to looking back on all this April 28, 2016

Filed under: medschool — excitablescientist @ 9:30 pm

We’ve been advised not to share details of adverse clinical experiences publicly, so I won’t, but I’ll say I’m looking very forward to the day when the notion that instilling fear in students is an effective way to teach is greeted with the ridicule it deserves.

 

Empathically ponderable April 13, 2016

Filed under: medschool — excitablescientist @ 9:27 pm

From Leslie Jamison’s The Empathy Exams:

“I needed something from the world I didn’t know how to ask for. I needed people—Dave, a doctor, anyone—to deliver my feelings back to me in a form that was legible. Which is a superlative kind of empathy to seek, or to supply: an empathy that rearticulates more clearly what it’s shown.”

“A 1983 study titled “The Structure of Empathy” found a correlation between empathy and four major personality clusters: sensitivity, nonconformity, even temperedness, and social self-confidence. I like the word structure. It suggests empathy is an edifice we build like a home or office—with architecture and design, scaffolding and electricity.”

“Empathy isn’t just something that happens to us—a meteor shower of synapses firing across the brain—it’s also a choice we make: to pay attention, to extend ourselves. It’s made of exertion, that dowdier cousin of impulse. Sometimes we care for another because we know we should, or because it’s asked for, but this doesn’t make our caring hollow. The act of choosing simply means we’ve committed ourselves to a set of behaviours greater than the sum of our individual inclinations: I will listen to his sadness, even when I’m deep in my own. To say going through the motions—this isn’t reduction so much as acknowledgement of effort—the labor, the motions, the dance—of getting inside another person’s state of heart or mind.

This confession of effort chafes against the notion that empathy should always rise unbidden, that genuine means the same thing as unwilled, that intentionality is the enemy of love. But I believe in intention and I believe in work. I believe in waking up in the middle of the night and packing our bags and leaving our worst selves for our better ones.”

 

Surfacing April 5, 2015

Filed under: academia,grad school,medschool — excitablescientist @ 10:27 pm

For a while, I’ve been meaning to write about what an incredible change medical school has been, but I struggle to find words for the overwhelming gratitude I feel for it daily. It’s probably the best thing that ever happened to me.

It’s also hard to write about this without showing contempt of the many wonderful aspects of grad student life generally and the lab I work in specifically. But after being introduced to a field that places primary value on relationships and caring service for people and communities, I can’t see myself continuing my career in a field that is guided by the singular goal of individual achievement – defined by outcompeting your peers – any more than I can see myself becoming an Olympic athlete.

Despite being in the most supportive research environment I could imagine, I found the competitiveness of academic science soul-destroying, and didn’t fully realize the extent of it until this year. From talking to scientist colleagues in other fields, it seems that cancer research is particularly known for this. I still find it puzzling, given that nearly all the people I’ve worked with have been very collegial and collaborative and willing to share their expertise. But I don’t really want to talk about how this plays out for other people because those aren’t my stories to tell. I want to talk about the effect it had on me.

Having a publication accepted or advancing through the selection cycles of a scholarship competition felt really, really good. Maybe too good. Kind of addictive. I derived a good portion of my sense of self-worth by how I ranked against other applicants – not by how I treated people or based on how useful my work was likely to be to anyone except my own career. I also got a sinking feeling when people I perceived as rivals experienced similar success. I knew something was wrong when I realized I was envious even of my friends. These aren’t things I’m proud to admit, but they’re real and not altogether unanticipated consequences of the system of incentives set up for scientists today.

I was also getting really tired of the siloed thinking that so often permeates highly specialized fields, and of hearing that so many injustices staring us in the face “aren’t our problem” and having the conversation end there. While people have argued that scientists aren’t valued enough, the billions of dollars in research funding we receive, with almost no strings attached, testifies to the political clout we wield. And we don’t hesitate to use it to our own benefit, but we could do so much more. I would argue the least biomedical researchers can do is acknowledge the limitations of our own work and use the influence we have to amplify voices that are preferentially unheard (for example, those calling for dismantling systems of oppression as a way to support flourishing population health). Dr. Ruha Benjamin has some brilliant thoughts on how this might be achieved.

Last summer I attended a conference talk where a highly influential scientist in my field suggested that at least some of us in the audience should spend the rest of our lives on highly technical investigations of a rare type of cancer where the researcher:patient ratio is already close to 1:1. I felt like I was on another planet. While writing this post, a friend (who, obvs, knows me well) sent along a very relevant quote from Charlie Chaplin’s film The Great Dictator, which is very reminiscent of the thoughts that were running through my head then:

We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical. Our cleverness, hard and unkind. We think too much and feel too little. More than machinery we need humanity. More than cleverness we need kindness and gentleness. Without these qualities, life will be violent and all will be lost….

I’ve got a long way to finishing my PhD, and who knows how I’ll feel in the 7+ years it’ll take to finish med school. But for now, I can’t imagine anything more fulfilling than this description of family medicine by a particularly inspiring doctor who spoke to us a few weeks ago:

You see patients get better and walk with them along their journey.

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Garibaldi Park, Skwxwú7mesh and Lil’wat traditional territory

 

Trailing Clouds February 5, 2015

Filed under: life outside the lab,medschool,social justice — excitablescientist @ 12:24 am

Today’s edition of our medical humanities class was one of the most special (and emotional) lectures I have attended in med school thus far. It was on prison health, which has increasingly been on my mind, for reasons I’ll leave for another post (but, briefly, including Marissa Alexander, Raif BadawiBaher Mohamed, Mohamed Fahmy and Peter Greste, among countless other people imprisoned without just cause, a reality to which I feel screaming is the only appropriate response)

Our small group had a chance to talk to a previously incarcerated woman about her experiences with the health care system, and at the end of the day I had the special opportunity to meet her beautiful baby. Being a witness to this ubiquitous yet extraordinary mother-child bond and the incredible renewal of life it represents brought to mind a memorable line from a memorable sermon (Jan. 11th) by Rev. Dan Chambers:

A baby is received into the world still trailing clouds of glory, with eternity shining in her eyes. 

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Photo from Flickr user Dennis Amith, used under CC BY-NC 2.0 license.