Ok, so I'm making this a quick update. I've been getting a little behind on my posting, but I think things will settle down for me a bit in the upcoming weeks. I have had some significant hoops to jump through in terms of my medical school application (for anyone thinking about applying to med. school, I'll go ahead and warn you that AMCAS is a major pain!).
Alas, I have finished and my application is finally submitted.
While I do love my internship, the highlight of this last week for me was going to Amelia Island, Florida. My family goes just about every year and it's A-W-E-S-O-M-E. I had a great time getting some R&R, and eating lots of good food.
In internship update news:
For this last week, all of the interns got to sit in on clerkships for the second year med students as they transition to their third years. It was great for me and the other interns because the med. school did a lot of "basic" reviews for the students. I got to sit in on a number of really interesting lectures and classes: I heard a lecture on reading EKGs and ABGs. I found this lecture intriguing but, as usual, a little beyond me. Although, I got better at determining and reading some of the EKGs. We had a couple of practice cases where the lecturers gave the students a chance to tell them what they noticed about different EKGs. I got to the point where I could tell when something was wrong (or different from a "normal" EKG, at least).
ABGs are pretty interesting too. I found those to be a little more easy to grasp (at least for the purposes of our practice cases).
Over the clerkship, I got to sit in on a class on ATLS, pediatrics, and airways.
One of the more memorable classes, at least for me, was a class on suturing. The med. students were given pig's feet and practiced suturing and stitching with those (pig's feet are similar to the feel texture of human skin). The knots we learned were really basic. The other interns and I had to wait until all of the med. students had the opportunity to suture up pig's feet until we were allowed to practice. While stitching up a pig's foot might sound gross or boring to some of you, it was a good time. I can't say that I'm particularly good at suturing, but I'll have plenty of time to practice, I'm sure!
Anyways, it was another crazy week and I'm sure next week will be more of the same.
Expect a longer update next time!
Extremely tired,
Peter
Sunday, June 26, 2011
Wednesday, June 15, 2011
Anatomy Camp
Ok, so it's been a while since I updated. I have been pretty busy finishing up my medical school application and a little bit scatterbrained between getting a job and doing some other stuff. In any case, I have done so many things in the past week in a half or so, that I will not be able to talk about it all.
**Reader Alert**
Since I haven't been able to update for a while, this will be a long post! I don't want to ramble on, but I really should have updated more frequently the past week. In any case, if you don't want to read, you don't have to (obviously).
Also, I have been immersed in a lot of medical jargon recently. So for those of you who are not in medicine, I apologize for the overabundance of technical terms. I'm a nerd, so I love learning these terms. But, I realize that not everybody feels this way! Sorry if they bother you.
I'll start with Monday of last week.
In the morning I arrived to the simulation room to find a "syndaver" laid out on a bed. A "syndaver" is exactly what it sounds like, a synthetic cadaver. After working with real (and smelly) cadavers, I was a bit skeptical of synthetic replications. But, I have to admit, the syndaver was pretty real and pretty smelly itself. Instead of the formaldehyde smell that you get with real cadavers, the sydaver smells like seafood or something. I'm not sure which smell is more gross! Just to add to the weirdness, the synthetic materials used to make the syndaver muscles look like the skin of crayfish, or lobster or something. The muscles are kind of spotted and pinkish, just like crustaceans.
However, as I was saying the syndaver is remarkably realistic. And I even overheard some of the doctors talking about how syndavers might replace the need for cadavers in medical schools (although, I think this is unlikely. . . then again, I'm not a doctor). Also, it's hard to imagine a synthetic cadaver ever truly replacing an actual body, no matter how realistic it is.
Anyways, the point of having the syndaver was that we (the interns) got to learn and practice ATLS (Advanced Trauma Life Support) skills. ATLS skills are the kind of procedures that you really hope you never have to have or do to another person. Of course, the surgeon who came in and showed us all of the procedures has to perform these sorts of things on a fairly regular basis. Dr. D demonstrated to us how to place a chest tube to relieve a tension pneumothorax (a condition where pressure builds up in the pleura and can result in an inability to breathe, or more importantly kink the inferior vena cava such that your heart cannot pump blood), a DPL (Diagnostic Peritoneal Lavage), and a procedure to remove the blood from the pericardium with a needle (although she said that surgeons hardly ever did this procedure).
All of the techniques were really cool, but I really enjoyed putting in the chest tube. It's a pretty violent procedure, to be honest. But there's a reason it's a trauma procedure. Dr. D was awesome. She was clearly knowledgeable about all of these techniques, but she was happy to carefully teach us all of them. All of the interns got a chance to practice the different procedures. I felt pretty comfortable doing them, but I was hardly in the high-pressure, high-stress kind of situation that a trauma would be.
After we had punctured most of the syndaver's intercostal spaces for chest tubes, A (the other intern) and I helped run some simulations for training LPNs. It was interesting, but nothing too out of the ordinary.
Tuesday, was my favorite day I've had in this internship. The morning started off "Anatomy Camp." Anatomy Camp is a special four-day long event that Quillen runs for CRNAs from VCU. I'm not really sure why we have people come in from VCU, but the camp is awesome nonetheless. First Dr. K gave a lecture for about an hour and half on the anatomy of the airway (larynx, pharynx, etc.). The lecture was really fascinating, but probably a bit over my head. For obvious reasons, the lecture focused on what nerves controlled what parts of the throat (extremely important for anesthesiology). I can remember Dr. K cracking some corny joke in his lecture: He said, "If I asked you the question, 'what nerves control three out of the four infrahyoid muscles?", could you give me the ansa?" (The ansa cervicalis is the loop of nerves that does this).
After our lecture we went to the gross anatomy lab and looked at the airways on a couple of cadavers. The lab was really helpful because they had people lined up at eight different stations explaining different parts of the anatomy, etc.
In the afternoon, I had some pizza for lunch, courtesy of anatomy camp and helped run a couple more simulations for the LPNs.
Once we were done with the simulations we had another lecture on neuraxial blockades. All of this lecture was, of course, extremely fascinating and mostly over my head. Although, by the end of the week I was starting to remember more and more, and to understand what was going on.
The rest of the week was much of the same stuff. I'll go through some of the highlights.
Wednesday was another day of lectures and labs. We focused on interscalene and supraclavicular blocks.
After our day of lecture/lab, we had a party over at Dr. E's in the evening. The party was great. It was really fun meeting some of the CRNAs and just hanging out with some of the other doctors and interns. Mostly it was just fun to talk to some of these people outside of an academic/medical context.
On Thursday we talked about the brachial plexus mostly. The brachial plexus is fairly complex and I was pretty confused by the whole thing at first. But after seeing it multiple times, it's starting to stick. I even practiced drawing it the other day. It's pretty difficult to draw considering all the posterior and anterior divisions/cords/branches, etc. I'm starting to learn some of the nerves and which regions of the body are innervated by those nerves. For example, Dr. K told us that any time you are dealing with the shoulder, you are dealing with nerves C5 and C6 (cervical nerves 5 and 6).
Friday, I had the notable honor of allowing 20 - 30 CRNAs ultra-sound my femoral. Needless to say, it was a little bit awkward. The femoral artery is REALLY close to genitalia. Despite my anxiety, it wasn't that bad. Everyone was there to learn. . . Besides, I'll probably never see many of those CRNAs again. Even if I do, who cares?
That concludes Anatomy Camp. It was an amazing week and I learned an incredible amount from it. Really, I was pretty spoiled to be able to sit on all the lectures and labs.
Now for a non sequitur:
I've been learning a lot of nifty mnemonics for different parts of the anatomy. Here are the ones I can remember.
Randy Taylor Drinks Cold Beer - This is for remembering the subunits of the brachial plexus: Roots, Trunks, Divisions, Cords, Branches.
NAVEL - This is mnemonic for what you run into in the leg, lateral to medial: Nerve, Artery, Vein, [Empty Space], Lymph
SLI - The three muscles of the erector spinae (medial to lateral): Spinalis, Longissimus, Iliocostalis
SITS - The four rotator cuff muscles: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.
PAD from the inside out - The layers of the spinal cord from deep to superficial: Pia Mater, Arachnoid, Dura Mater.
I'll be more up-to-date in the coming weeks.
Happy to be a camper again,
Peter
**Reader Alert**
Since I haven't been able to update for a while, this will be a long post! I don't want to ramble on, but I really should have updated more frequently the past week. In any case, if you don't want to read, you don't have to (obviously).
Also, I have been immersed in a lot of medical jargon recently. So for those of you who are not in medicine, I apologize for the overabundance of technical terms. I'm a nerd, so I love learning these terms. But, I realize that not everybody feels this way! Sorry if they bother you.
I'll start with Monday of last week.
In the morning I arrived to the simulation room to find a "syndaver" laid out on a bed. A "syndaver" is exactly what it sounds like, a synthetic cadaver. After working with real (and smelly) cadavers, I was a bit skeptical of synthetic replications. But, I have to admit, the syndaver was pretty real and pretty smelly itself. Instead of the formaldehyde smell that you get with real cadavers, the sydaver smells like seafood or something. I'm not sure which smell is more gross! Just to add to the weirdness, the synthetic materials used to make the syndaver muscles look like the skin of crayfish, or lobster or something. The muscles are kind of spotted and pinkish, just like crustaceans.
However, as I was saying the syndaver is remarkably realistic. And I even overheard some of the doctors talking about how syndavers might replace the need for cadavers in medical schools (although, I think this is unlikely. . . then again, I'm not a doctor). Also, it's hard to imagine a synthetic cadaver ever truly replacing an actual body, no matter how realistic it is.
Anyways, the point of having the syndaver was that we (the interns) got to learn and practice ATLS (Advanced Trauma Life Support) skills. ATLS skills are the kind of procedures that you really hope you never have to have or do to another person. Of course, the surgeon who came in and showed us all of the procedures has to perform these sorts of things on a fairly regular basis. Dr. D demonstrated to us how to place a chest tube to relieve a tension pneumothorax (a condition where pressure builds up in the pleura and can result in an inability to breathe, or more importantly kink the inferior vena cava such that your heart cannot pump blood), a DPL (Diagnostic Peritoneal Lavage), and a procedure to remove the blood from the pericardium with a needle (although she said that surgeons hardly ever did this procedure).
All of the techniques were really cool, but I really enjoyed putting in the chest tube. It's a pretty violent procedure, to be honest. But there's a reason it's a trauma procedure. Dr. D was awesome. She was clearly knowledgeable about all of these techniques, but she was happy to carefully teach us all of them. All of the interns got a chance to practice the different procedures. I felt pretty comfortable doing them, but I was hardly in the high-pressure, high-stress kind of situation that a trauma would be.
After we had punctured most of the syndaver's intercostal spaces for chest tubes, A (the other intern) and I helped run some simulations for training LPNs. It was interesting, but nothing too out of the ordinary.
Tuesday, was my favorite day I've had in this internship. The morning started off "Anatomy Camp." Anatomy Camp is a special four-day long event that Quillen runs for CRNAs from VCU. I'm not really sure why we have people come in from VCU, but the camp is awesome nonetheless. First Dr. K gave a lecture for about an hour and half on the anatomy of the airway (larynx, pharynx, etc.). The lecture was really fascinating, but probably a bit over my head. For obvious reasons, the lecture focused on what nerves controlled what parts of the throat (extremely important for anesthesiology). I can remember Dr. K cracking some corny joke in his lecture: He said, "If I asked you the question, 'what nerves control three out of the four infrahyoid muscles?", could you give me the ansa?" (The ansa cervicalis is the loop of nerves that does this).
After our lecture we went to the gross anatomy lab and looked at the airways on a couple of cadavers. The lab was really helpful because they had people lined up at eight different stations explaining different parts of the anatomy, etc.
In the afternoon, I had some pizza for lunch, courtesy of anatomy camp and helped run a couple more simulations for the LPNs.
Once we were done with the simulations we had another lecture on neuraxial blockades. All of this lecture was, of course, extremely fascinating and mostly over my head. Although, by the end of the week I was starting to remember more and more, and to understand what was going on.
The rest of the week was much of the same stuff. I'll go through some of the highlights.
Wednesday was another day of lectures and labs. We focused on interscalene and supraclavicular blocks.
After our day of lecture/lab, we had a party over at Dr. E's in the evening. The party was great. It was really fun meeting some of the CRNAs and just hanging out with some of the other doctors and interns. Mostly it was just fun to talk to some of these people outside of an academic/medical context.
On Thursday we talked about the brachial plexus mostly. The brachial plexus is fairly complex and I was pretty confused by the whole thing at first. But after seeing it multiple times, it's starting to stick. I even practiced drawing it the other day. It's pretty difficult to draw considering all the posterior and anterior divisions/cords/branches, etc. I'm starting to learn some of the nerves and which regions of the body are innervated by those nerves. For example, Dr. K told us that any time you are dealing with the shoulder, you are dealing with nerves C5 and C6 (cervical nerves 5 and 6).
Friday, I had the notable honor of allowing 20 - 30 CRNAs ultra-sound my femoral. Needless to say, it was a little bit awkward. The femoral artery is REALLY close to genitalia. Despite my anxiety, it wasn't that bad. Everyone was there to learn. . . Besides, I'll probably never see many of those CRNAs again. Even if I do, who cares?
That concludes Anatomy Camp. It was an amazing week and I learned an incredible amount from it. Really, I was pretty spoiled to be able to sit on all the lectures and labs.
Now for a non sequitur:
I've been learning a lot of nifty mnemonics for different parts of the anatomy. Here are the ones I can remember.
Randy Taylor Drinks Cold Beer - This is for remembering the subunits of the brachial plexus: Roots, Trunks, Divisions, Cords, Branches.
NAVEL - This is mnemonic for what you run into in the leg, lateral to medial: Nerve, Artery, Vein, [Empty Space], Lymph
SLI - The three muscles of the erector spinae (medial to lateral): Spinalis, Longissimus, Iliocostalis
SITS - The four rotator cuff muscles: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis.
PAD from the inside out - The layers of the spinal cord from deep to superficial: Pia Mater, Arachnoid, Dura Mater.
I'll be more up-to-date in the coming weeks.
Happy to be a camper again,
Peter
Thursday, June 2, 2011
Start of the ETSU Patient Simulation Lab
I started up my internship at the ETSU Patient Simulation Lab yesterday. . .
I honestly don't know where to start, or how to talk about everything I've experienced so far. But I'll do my best to describe some of the better experiences.
We started off yesterday with a small orientation. It was really basic and we just looked at the calendar and discussed what we would be doing throughout the summer. Right from the start, I knew the internship was going to be awesome: The calendar was filled with multiple opportunities to observe and learn from physicians. For the summer, we will be helping prepare cadavers for medical students, assisting in running a camp for high schoolers interested in medicine, listening in on lectures by various physicians, and much more.
Orientation was fine, but unremarkable. After about an hour, our program coordinator told us we could either leave or go down to the Gross Anatomy Lab and work with cadavers.
I knew I couldn't simply leave, and I was really excited about working with the cadavers (as weird as that may sound to some people), but I was apprehensive nonetheless. Before we went into the lab, our coordinator kept reminding us to sit down if we felt light-headed or dizzy. I wasn't really sure how I would react to the bodies, and I could feel myself getting more nervous as we approached the lab.
As we stepped into the lab, however, I suddenly didn't feel as nervous. It's still a little bit surreal to me, but I actually felt more calm and comfortable once we got into the lab with the bodies. We all put gloves on and grabbed our tools (scalpels, hemostats, scissors, etc.).
Before I go any further, I should talk a little about the "cadaver experience." In my opinion, there is no way to get around the fact that cutting up a dead human body is a bit creepy. Let's face it, if someone didn't feel a little weird while they were working with a cadaver, that would be really creepy. Ultimately, you simply have to come to grips with the fact that all of the bodies in the lab belonged to someone.
But something weird happens when you start working with bodies. You learn to dissociate yourself from the cadaver. So while I acknowledged the fact that I was dissecting a human body--a body that had a life and history--I didn't dwell on that reality. It's hard to explain. There is a way that I can appreciate the person who donated their body to science, and be grateful for the opportunity to learn from it, but push aside the unpleasant thoughts of cutting into a human body. Weirdly enough, you get so caught up in concentrating on what you are doing, that you almost forget that you're cutting up a body. I know that sounds crazy, but it's true.
In any case, within an hour of orientation, I was given the green-light on a cadaver. My assignment was to expose the brachial plexus, a network of nerves located in the upper part of the arm (essentially the armpit/shoulder area). As I began removing tissue and fat, I remembered having heard that your finger is the best tool you have in dissecting a body. The first few minutes, I was pretty timid. I would grab the forceps and a scalpel and carefully remove pieces of tissue. Well, it didn't take long for me to realize that I was going to be in the lab for a long time if I continued to cut that way. As I grew bolder, I began to use my fingers to tear apart muscle fibers and remove layers of fat.
Nerves are a relatively easy find in the body because they are long yellowish-white fibers, hidden behind a layer of muscles. They are great for novices like me too, because they are virtually impossible to sever unless you took a pair of scissors to them. Essentially, you won't break them if you are simply poking around with your hands.
I was fortunate enough to rope in a fourth year medical student, R, to help me with the dissection. I was so surprised by her willingness to help. I expected her to give me a few pointers on how to remove some of the tissue, but instead she hung out at my table for a solid hour to hour and a half.
After we finished up in the gross lab, one of the other interns suggested we go swimming in the Nolichucky River. I had nothing better to do, and I was curious to meet some of the other interns for the summer. So J, A, R, and I went to a spot called "Big Rock" on the Nolichucky. The place was really cool, but my fellow interns were even cooler. It was really fun to just hang out and get to know each other better.
All of this was just my first day.
We did even more stuff today, but I'll give an abbreviated version:
In the morning I helped with a laminectomy. This is a process where you remove the dorsal part of the spine (the lamina) from the vertebral column. Next we exposed the nerves running from the spinal cord beneath the ribs (the intercostal nerves).
I held a brain.
We helped run various OB/GYN simulations for the medical students. Then we listened to a Doctor H debrief on the various scenarios to the students. These debriefs were filled with lots of stuff that went right over my head, but were extremely interesting nonetheless.
After the simulations, I learned how to intubate someone ( I practiced on our sim lab dummy) and how to start a catheter in a vein. I also learned BLS (Basic Life Support), which essentially amounts to CPR.
I've had two jam-packed days, I can't wait to say more about it. But this post is already getting a bit lengthy, so I'll save my thoughts for later.
I still can't believe I held a brain today,
Peter
I honestly don't know where to start, or how to talk about everything I've experienced so far. But I'll do my best to describe some of the better experiences.
We started off yesterday with a small orientation. It was really basic and we just looked at the calendar and discussed what we would be doing throughout the summer. Right from the start, I knew the internship was going to be awesome: The calendar was filled with multiple opportunities to observe and learn from physicians. For the summer, we will be helping prepare cadavers for medical students, assisting in running a camp for high schoolers interested in medicine, listening in on lectures by various physicians, and much more.
Orientation was fine, but unremarkable. After about an hour, our program coordinator told us we could either leave or go down to the Gross Anatomy Lab and work with cadavers.
I knew I couldn't simply leave, and I was really excited about working with the cadavers (as weird as that may sound to some people), but I was apprehensive nonetheless. Before we went into the lab, our coordinator kept reminding us to sit down if we felt light-headed or dizzy. I wasn't really sure how I would react to the bodies, and I could feel myself getting more nervous as we approached the lab.
As we stepped into the lab, however, I suddenly didn't feel as nervous. It's still a little bit surreal to me, but I actually felt more calm and comfortable once we got into the lab with the bodies. We all put gloves on and grabbed our tools (scalpels, hemostats, scissors, etc.).
Before I go any further, I should talk a little about the "cadaver experience." In my opinion, there is no way to get around the fact that cutting up a dead human body is a bit creepy. Let's face it, if someone didn't feel a little weird while they were working with a cadaver, that would be really creepy. Ultimately, you simply have to come to grips with the fact that all of the bodies in the lab belonged to someone.
But something weird happens when you start working with bodies. You learn to dissociate yourself from the cadaver. So while I acknowledged the fact that I was dissecting a human body--a body that had a life and history--I didn't dwell on that reality. It's hard to explain. There is a way that I can appreciate the person who donated their body to science, and be grateful for the opportunity to learn from it, but push aside the unpleasant thoughts of cutting into a human body. Weirdly enough, you get so caught up in concentrating on what you are doing, that you almost forget that you're cutting up a body. I know that sounds crazy, but it's true.
In any case, within an hour of orientation, I was given the green-light on a cadaver. My assignment was to expose the brachial plexus, a network of nerves located in the upper part of the arm (essentially the armpit/shoulder area). As I began removing tissue and fat, I remembered having heard that your finger is the best tool you have in dissecting a body. The first few minutes, I was pretty timid. I would grab the forceps and a scalpel and carefully remove pieces of tissue. Well, it didn't take long for me to realize that I was going to be in the lab for a long time if I continued to cut that way. As I grew bolder, I began to use my fingers to tear apart muscle fibers and remove layers of fat.
Nerves are a relatively easy find in the body because they are long yellowish-white fibers, hidden behind a layer of muscles. They are great for novices like me too, because they are virtually impossible to sever unless you took a pair of scissors to them. Essentially, you won't break them if you are simply poking around with your hands.
I was fortunate enough to rope in a fourth year medical student, R, to help me with the dissection. I was so surprised by her willingness to help. I expected her to give me a few pointers on how to remove some of the tissue, but instead she hung out at my table for a solid hour to hour and a half.
After we finished up in the gross lab, one of the other interns suggested we go swimming in the Nolichucky River. I had nothing better to do, and I was curious to meet some of the other interns for the summer. So J, A, R, and I went to a spot called "Big Rock" on the Nolichucky. The place was really cool, but my fellow interns were even cooler. It was really fun to just hang out and get to know each other better.
All of this was just my first day.
We did even more stuff today, but I'll give an abbreviated version:
In the morning I helped with a laminectomy. This is a process where you remove the dorsal part of the spine (the lamina) from the vertebral column. Next we exposed the nerves running from the spinal cord beneath the ribs (the intercostal nerves).
I held a brain.
We helped run various OB/GYN simulations for the medical students. Then we listened to a Doctor H debrief on the various scenarios to the students. These debriefs were filled with lots of stuff that went right over my head, but were extremely interesting nonetheless.
After the simulations, I learned how to intubate someone ( I practiced on our sim lab dummy) and how to start a catheter in a vein. I also learned BLS (Basic Life Support), which essentially amounts to CPR.
I've had two jam-packed days, I can't wait to say more about it. But this post is already getting a bit lengthy, so I'll save my thoughts for later.
I still can't believe I held a brain today,
Peter
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