Posts tagged clerkship

πάθει μάθος

From the Agamemnon of Aeschylus (written c. 458 BCE)

Pathei Mathos can be translated as learning from adversary, or wisdom arises from (personal) suffering, or personal experience is the genesis of true learning.

Understood in its original context, Aeschylus expresses that wisdom arising from personal experience is more valuable than what any impersonal words, faith, or doctrine can impart to us. 

MD: A Degree in Review

It still shocks me that I am only a few days away from beginning my residency. Four years have come and gone. I now have a degree and letters behind my name to show for it. This last year has presented with its own unique challenges and a lot has changed in four years. Let’s have a look back.

Year One

It was here that I first learned how to correctly use my stethoscope, how to speak with patients, and how to act like a doctor. These were my baby steps. I studied a whole host of topics, covering the broadest and biggest organ systems. It was also here that I learned anatomy and had the privilege to work with cadavers. 

Year Two

In many respects this was the most stressful year. While clinical work is taxing in its own right, nothing came close to the mental toll this year had on me. Studying was both a necessity and a compulsion. Easily I spent entire days sitting a library, reading, memorizing, understanding. I had never studied that much in my entire life.

Year Three

This time, the stresses of clinical work were balanced between the mental and the physical. By far the most challenging year of all but also the most enjoyable. Having sat in class for the better part of my life, now I would have to do.

It was an adjustment to work in a hospital, to see volumes of patients, to do call shifts. But I adjusted and grew used to the pace of the ward. Gradually, I learned to move from knowing how, to showing how, to doing.

Year Four

On top of the clinical work, I had a number of additional challenges this year. I had an all encompassing OSCE, residency applications and touring, and a licensing exam to complete. By this point, clinical rotations were not quite as overwhelming or scary as they used to be, but I still had many hard days.

The brunt of the stress this year came from the latter additions. Those three things were for all the marbles, and the consequences of missing any one of those were a constant worry. The OSCE wound up showing some of my weaknesses that I would need to improve on. The CaRMS tour would take me across the country from colder to coldest winters in Canada. The licensing exam ended up being a two-week mad dash to the finish line. For six months, the pressures mounted through these three main events.

But I eventually reached the end of my four year journey. I graduated, I was admitted to a residency program, and I passed my exam. 

It has been a roller coaster ride through four years of medical school. I am happy I could document it all here in these posts. Now I start a different journey through residency and look forward to reflecting more on this new adventure.

Today…

…is my last clinical day of medical school.

…is my last day seeing patients before residency.

…is my last day introducing myself to patients as a medical student.

Though I still have a month plus change of classes before school is officially over, I am both excited and terrified of what is to come.

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Sushi Night.
It was the end of a very long day. We had skipped lunch to catch up on our patient load and I was famished. I hopped into my car and proceeded to the nearest restaurant I could find, a sushi joint.
I made a beeline for the take out section and found what I was looking for: a party platter. 
"Do you need chopsticks to go?" asked the cashier.
"Yes, please."
"How many sets?" I paused and pondered. Should I be honest? Just say one? No, I will look like a pig. Just lie to not look desperate.
"Um…four."
She started packing my purchase for my supposed night of fun and games with friends.
Nay, there would be no such thing. Just a stack of study books, sushi, and four sets of chopsticks. 

Sushi Night.

It was the end of a very long day. We had skipped lunch to catch up on our patient load and I was famished. I hopped into my car and proceeded to the nearest restaurant I could find, a sushi joint.

I made a beeline for the take out section and found what I was looking for: a party platter. 

"Do you need chopsticks to go?" asked the cashier.

"Yes, please."

"How many sets?" I paused and pondered. Should I be honest? Just say one? No, I will look like a pig. Just lie to not look desperate.

"Um…four."

She started packing my purchase for my supposed night of fun and games with friends.

Nay, there would be no such thing. Just a stack of study books, sushi, and four sets of chopsticks. 

Post-CaRMS Sentiments.
I have had the pleasure of meeting a number of my classmates while on rotation. We discussed not just our match results but also how our respective electives were going. With the anxiety and tension of CaRMS gone, the sentiment has been universal: boredom.
To be fair the learning on service is impeccable and the opportunities great. But having reached the climactic finish we have worked towards for the better part of year, there is now the slow creep of impatience. The effect is only compounded if one is not on a service they have matched to.
"Are we there yet?"
74 days until graduation.

Post-CaRMS Sentiments.

I have had the pleasure of meeting a number of my classmates while on rotation. We discussed not just our match results but also how our respective electives were going. With the anxiety and tension of CaRMS gone, the sentiment has been universal: boredom.

To be fair the learning on service is impeccable and the opportunities great. But having reached the climactic finish we have worked towards for the better part of year, there is now the slow creep of impatience. The effect is only compounded if one is not on a service they have matched to.

"Are we there yet?"

74 days until graduation.

Cannot Sleep

I have quiet time on call and I cannot bring myself to sleep. I feel like a zombie.

Regular Customer. 

I walked into the busy Starbucks within the hospital to make my order. It had been a rather sleepless night before. As I made eye contact with the barista at the counter, I had barely opened my mouth before she cut me short. 

"A tall Americano with room, Tom?" 

I was taken aback. Not only did she remember my name, she remembered my order. 

"Um…yes, that’s right," I said, surprised. She quickly had my order ready. The entire process was seamless. While slick, it highlighted something about my routines. 

There is no better gauge that I come to Starbucks too often than when orders happen before I even speak.

Regular Customer.

I walked into the busy Starbucks within the hospital to make my order. It had been a rather sleepless night before. As I made eye contact with the barista at the counter, I had barely opened my mouth before she cut me short.

"A tall Americano with room, Tom?"

I was taken aback. Not only did she remember my name, she remembered my order.

"Um…yes, that’s right," I said, surprised. She quickly had my order ready. The entire process was seamless. While slick, it highlighted something about my routines.

There is no better gauge that I come to Starbucks too often than when orders happen before I even speak.

Cultural References

  • Doctor: You see this wiggly thing? That's a camera. It lets me look inside your nose!
  • Child: Ew! That's yucky!
  • Doctor: Do you remember that episode in Magic School Bus? When Ms. Frizzle's bus gets all teeny tiny and goes exploring Ralphie's nose?
  • Child: What's the Magic School Bus?
  • Doctor: The...it was this awesome show on television...hmm...(to the mother) you know what I'm talking about, right?
  • Mother: Haha, yes. I used to watch that a lot when I was babysitting my neighbour's kids.
  • Doctor: ...(to me) you watched Magic School Bus, right?
  • Me: I did.
  • Doctor: Phew...thought I was ancient for a moment there...ahem. Anyways, this is going to be like that.
 Cranial Nerve VII.
Lacrimal gland
Pterogopalatine ganglion
Motor nucleus of cranial nerve VII
Superior salivatory (lacrimal) nucleus
Nucleus solitarius (rostral gustatory portion)
Spinal nucleus of trigeminal nerve
Internal acoustic meatus
Stylomastoid foramen
Petrotympanic fissure (chorda tympani nerve)
Submandibular ganglion
Submandibular gland
Sublingual gland
Six branches of cranial nerve VII of head and neck expression
Temporal nerve: Frontalis muscle
Zygomatic nerve: Orbicularis oculi muscle
Buccal nerve: Buccinator and orbicularis oris muscle
Marginal mandibular nerve: Orbicularis oris muscle
Cervical nerve: Platysma muscle
Posterior auricular nerve: Occipitalis muscle

 Cranial Nerve VII.

  1. Lacrimal gland
  2. Pterogopalatine ganglion
  3. Motor nucleus of cranial nerve VII
  4. Superior salivatory (lacrimal) nucleus
  5. Nucleus solitarius (rostral gustatory portion)
  6. Spinal nucleus of trigeminal nerve
  7. Internal acoustic meatus
  8. Stylomastoid foramen
  9. Petrotympanic fissure (chorda tympani nerve)
  10. Submandibular ganglion
  11. Submandibular gland
  12. Sublingual gland

Six branches of cranial nerve VII of head and neck expression

  1. Temporal nerve: Frontalis muscle
  2. Zygomatic nerve: Orbicularis oculi muscle
  3. Buccal nerve: Buccinator and orbicularis oris muscle
  4. Marginal mandibular nerve: Orbicularis oris muscle
  5. Cervical nerve: Platysma muscle
  6. Posterior auricular nerve: Occipitalis muscle
A thorough physical exam was deferred as patient was noncooperative and threatened to spit and defecate on me.
A vivid consultation report.