Archive for tag: classes

Crunch-Pop and Lovely, Intelligent Women

Here I sit, on a plane bound for Chicago after a weekend on the East Coast, listening to the air from the blower overhead and the rushing outside the window as we taxi. The deicers blast the window inches from my face with a heavy spattering sound. The engines roar a little louder and I think of the rattle my cousin's smiling, blonde 1-year-old used to fill my ears this morning.

At this past week's Nu Delta Sigma meeting, Nadene introduced us to sound healing as presented in the book, "Tuning the Human Biofield," by Eileen McKusick. I was the lucky recipient of a sound experiment from my friend John, a brilliant healer and doctor-in-the-making. You might call us crazy, but when was the last time you checked in with the sounds in your life? It had been a while for me.

The sim patient I saw this week in my Advanced Clinical Problem Solving class complained of tinnitus, a rushing sound in his ears, and was nearly deaf. This was the only abnormal finding on physical exam as we searched for clues to the cause of his dizzy, vomiting spells. When I made kale for dinner on Wednesday night, the leaves squeaked when I stripped them off their stalks. The sound reminded me of lemons and a crisp, cold, clear evening with a sky full of stars, when the frozen snow sings underfoot.

Selfie photo on the mountain
So excited to be out skiing in celebration of one of my very oldest friends!
(She taught me to suck my thumb when I was 2.)

When I rode the chairlift at Cranmore Mountain in New Hampshire with my childhood friends over the weekend, the chairs clunked as only chairlift chairs do each time you reach a tower. I reveled in the swish of skis and the crunch-pop of poles into snow, the whoosh and shudder of skiers of various skill levels as they rocket downhill beside you. There were also those split seconds of silence when I caught a little air and my skis left the snow, allowing me to hear only the wind in my ears.

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Beautiful bluebird day in the White Mountains! There are my friends, waving at me from the lift.

On Sunday morning, I listened to the coffee maker grumble and splurt that divine bitter stuff into the pot. The bottle of champagne made an adorable pop! And we toasted our friend, a bride-to-be. We thanked her for bringing together such an intelligent, fun, active and clever group of young women. Our glasses clinked! I am back at school now, refreshed and grateful.

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All the lovely, intelligent women in our PJs, toasting our bride-to-be!

So now I sit here typing, my fingers trickling across the keys making that distinct blipping sound with each letter. I spend so much time using my eyes and my hands to observe and palpate in medicine, but I haven't engaged nearly enough with my ears. The more blood pressures I take and the more lungs I auscultate, the more familiar those healthy sounds become. I listen to the normal sounds in hopes that I'll recognize when they are different, when the lungs pop or crackle or gurgle and tell me something about the environment inside my patient.

I Give You Permission to Research Colorful Sex

Where do we start when we talk about love in medicine? In naturopathic philosophy, love is one of our basic determinants of health; we require it to be truly well, just like we do air, water, and nutritious foods. But there are endless ways to love, and a doctor can never understand them all. What a doctor can do is appreciate love's presence with an open mind, without judgment, and with the awareness that love comes in all forms.

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(Image via www.dawn-productions.com)

Dr. Stephanie Draus' lecture in Clinical Problem Solving class this week was inspired by love. We discussed how to talk about sex with our patients. One excellent phrase I collected from her lecture was this: "Do you have sex with men, women, or both?" I never realized that question could be phrased with such simplicity. We talked about the out-dated stigmas attached to sexually transmitted diseases and why a lack of sex education causes these to run rampant, especially in the geriatric population.

We touched on the fact that sexual preference, desire, and practice are similarly stigmatized; we assume everyone having sex likes it "vanilla," that is to say, plain and simple, no bells and whistles, no games, nothing interesting. Just sex. As doctors, we cannot assume this about our patients, nor do we always need to know all the juicy details. What we do need to try to gather is whether our patients' health is at risk based on their sexual preferences, whether in regards to use of protection, or the myriad of alternative ways to experience pleasure.

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Mary Calderone was a physician and public health advocate for sexual education
(Image via izquotes.com)

So, what do we do as doctors-to-be if we find ourselves judging based on our own histories, the things we've been taught, or the lack thereof? I suppose the best place to start is by talking about it with our professors, and with each other. If you are someone who finds his or herself cringing inside at the notions of same-sex love or multiple lovers, I personally think you need to start learning by reading, listening, and well, Googling stuff. Perhaps your professors and friends can't or won't expound on the vastness of possibility and risk involved in more colorful sex, but we need to remain open to the frank notion that lots of people in our world experience pleasure in unorthodox ways. As doctors, we must be prepared to listen without judgment. We must also be willing to do our research so that we can advise our patients appropriately.

So, yes, in the name of becoming a better doctor, I am encouraging you to read up on any alternative sexual practices you can imagine. I've just given you the go-ahead to research gay culture, to wonder at how polyamory is comfortable for so many, to investigate the intricacies of anatomy and physiology in trans people, and to look up that thing you've always been curious about. I encourage you to explore resources for learning about and finding compassion for the zillion ways that one can love and be loved in this world.

My experience in finding acceptance for ways of loving that differ from my own can be understood like this: my partner doesn't like feta cheese. I like feta cheese! When I cook dinner with feta cheese (because I think its delicious!) he just decides to eat the food because he knows I'll be hurt if he doesn't eat what I've cooked, and you know what? After a few feta meals he decides he doesn't really hate feta cheese. After a few more feta meals, he decides he might actually kind of like feta cheese. What he does know is that he appreciates my satisfaction at the taste of this food, and he loves me, so he eats feta cheese for dinner with me. And of course, I do make sure to cook feta-less meals, too.

Orange Peel Appearance

What happens when you've been studying microbiology for your Part 1 boards and you see a sim patient in clinical problem solving class? You come up with a somewhat obscure viral infection as your diagnosis, when something along the lines of autoimmune disease was what your professors had in mind... Such was my first reminder this week to take a step back and remember the big picture. Who can blame me though, really? I've been busy!

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The Desert Room--where I found a good reading bench.

This week's second lesson in considering the totality of things also reminded me to make space for wonder. After picking up my new glasses on Saturday (Yay! Happy eyes!), I walked over to the Oak Park Conservatory to find a reading bench among the plants. It was late morning and there were small children exploring in each of the three greenhouse rooms. Most of them were working on a scavenger hunt prepared by the curators, but some were too small for that. I alternated between reading my NPLEX study guide and watching and listening to the small humans as they went through cycles of amazement (Mommy, Mommy look at the pink flower!) and frustration (I can't find the snake! Help me!)

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The Fern Room--where I sat to smell the flowers (no joke, so fragrant!).

Thankfully, I was granted about an hour of uninterrupted study time among the cacti during which I made some good headway through the section on the urinary system. Around the time I developed a numb butt from the wooden bench, I packed up my books and set to exploring the place with my new glasses on. I'm sure some of you reading this know that feeling of newly crisp vision; texture has returned to my world! I didn't plan it so, but the Conservatory was definitely one of the very best places I could go first with my sharp new eyes. The cacti were spiny, the tropical leaves were waxy, and the flowers were bright and complex. The climbing vines sprouted tiny brownish green curly-cues and the huge, fragrant lemons hanging on their branches were beautifully pock marked (What's that disease process I was just studying with "orange-peel appearance??")

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The Tropical Room--where I conversed with some parrots.

When I finally headed out, the volunteer docent was apologetic that I had to study over the sound of kids. I reassured her it was a welcome distraction, and a good reminder before I sit for my board exam to attend to all the possibilities. Also, that I should not forget to delight in the details.

Milestones

The first A, the first D, the first B when you thought it was going to be an F. There are many milestones that all of us at NUHS experience. They are the turning points that stick in our minds and mostly serve to boost us when we occasion to remember them.

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In the beginning -- my tri 1 lab group

There's the bittersweet end of pathology with Dr. Khan, and the viscera final aka your last anatomy practical ever! The first practical in the TAC shaking in your dress shoes and sweating through both your nice shirt AND your doctor coat. Grading yourself on that first practice spine and extremities practical and realizing you failed only to pass it when it comes to the real deal a week later. The first time you watch Dr. Lou take her shoes and socks off and not miss a beat in delivering her lecture.

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My group & me after our last ever anatomy practical (photo from Teegan)

The first time you've ever thought of J.Lo and a plumber in the same context, and the first time your head jerks up because Dr. McRae just SHOUTED in lecture. The moment when you realize that the 3-compartment model actually kind of makes sense (maybe). There's the first splash or smear of cadaver fat on your lab coat, and the first time you realize you're actually super hungry in the middle of dissection lab. Experiencing your first adjustment and then the first time you get a cavitation when giving someone else an adjustment, yes! The first exam during which you notice your palms are not sweaty and you're actually breathing just fine. The first time you forget to return the markers to the library desk and you have to pay a silly amount in fines (and decide to buy your own markers.)

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My nametag milestone

There's the last time you have Dr. Ed for class, and the last time you sit through one of Dr. Humphreys' neuro-heavy lectures. The moment you realize that Dr. Richardson's stories just keep getting better, so you vow to pay attention and you learn tons of pharmacology in the process. And then you realize that Dr. Ed had Dr. Christiansen as a professor, too. The day you receive your official intern nametag to be worn at all times in the clinic. The first time you tie a tourniquet and choose a vein in phlebotomy lab, and the first time you see the red flash. The first draw you mess up that either makes blood squirt, your patient cry out, or leaves behind a little hematoma (whoops!)

And then there are the things I haven't experienced yet but that I anticipate -- the first patient in clinic, the last patient in clinic. The first colonics patient, the first real live constitutional hydrotherapy you administer in clinic. And before you get to the clinic, there's the first real live gyn exam and digital rectal exam on a sym patient. Then, there's the first actual real patient presenting for a gyn exam, or the patient who refuses to receive a treatment you really think would help. The first time a patient cries in the exam room. There will be the patient who must be told the less-than-favorable results of a blood test; the patient that keeps you up at night wondering if you said the wrong thing, or the right thing. There will be the patient who isn't responding to treatment, and the patient who comes in singing your praises.

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Officially registered for boards

And then there is this week's milestone; registering for the NPLEX Part 1 Biomedical Science Examination. I've long been thinking about February's exam, but registering today made it REAL. Honestly, it's almost too bad I couldn't have registered several months ago, as it would've brought that realness to life at the time when I should have started taking my preparation more seriously. Oh, and there's another recent milestone; watching that first video in the board review series and having your eyebrows permanently raised in anguish as you painstakingly extract basic biochemistry from the recesses of your brain. You must take several deep breaths to calm those nerves you thought you were done with after that exam when you noticed your palms weren't sweaty and your breathing was even.

I have A LOT of information to retrieve from the depths and bring back to the forefront of my memory by the first week in February. I'm totally anxious about it, and every time I sit down to study, I have to fight the urge to ditch it and do something else that doesn't make me feel quite so bad about myself. Lately, I've been reflecting on how far I've come in order to remember that all the basic science information is there; I DO own it. Writing this post has helped me continue that affirmation process, and I hope it's maybe done the same for you in some way... or maybe it made you smile or laugh, or perhaps it made you curious about what lies in store.

My Favorite Tri So Far

I think Week 6 is a good time to get into the meat of what I've actually been up to so far in Tri 6. The best part about this trimester is that I spend relatively little time sitting in lecture, and most of my time applying and building upon what I already know through discussions and hands-on learning.

Physical and Laboratory Diagnosis (aka Phys Dx in student speak) is a beast of a class, with 6 hours per week of lecture and three more hours per week in lab. Our first practical comes this week, and I have been practicing several exams including taking vitals, as well as the head and neck, pulmonary, cardiovascular, neurological, eye, ear/nose/throat, and abdominal exams. Besides demonstrating that we can actually execute said exams, we will be tested on our ability to translate an objective finding into a diagnosis (for example, dullness on percussion of the lungs in the right upper lobe suggests consolidation and therefore pneumonia in that area.)

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Friday Manual Therapies class celebrations! Tony's birthday called for learning, pizza, and cupcakes.

Two other classes require me to sit in lecture. The first is Imagining Diagnosis, in which we just finished learning about how to recognize arthritides, like rheumatoid arthritis, on X-ray. The other is Ethical Practice Management, a class that discusses things like how to use twitter for marketing, and why networking is vital for success.

All my other courses are significantly more hands-on and interactive, the reason that this trimester is my favorite one so far. In Homeopathy 3, we sit in class, yes, but we learn remedies and have discussions about how to take a case, analyze a case, and subsequently find the correct remedy for a patient. In Applied Clinical Theory, we discuss paper cases each week and learn about how to make a diagnosis based on a history and results of a physical exam. Next, we discuss how to treat these patients by working through our therapeutic order and addressing each determinant that is out of balance.

These classes are directly allowing us to apply what we know and understand about pathology, physiology, biochemistry, anatomy, etc. (material from our first phase classes) to a theoretical patient. It is so satisfying to prepare for a class discussion and find out the next day that your diagnosis was correct and that some of the therapies you've chosen are the same ones your professor would apply!

These classes are helping me to move beyond simply identifying what is wrong with the body, to actually creating a treatment plan to solve the problem. I have two more hands-on labs that fill my week, one is phlebotomy lab where we've been learning to draw blood and take urine samples. The other is a class called Advanced Manual Therapies, which has proven to be a great review of evaluation techniques we learned in our E&M classes, and allows us to put it all together. For example, last week we learned the "upper extremity evaluation dance," which will help us to determine where a patient's source of pain or malfunction resides if they present with a problem in their arm or shoulder. We also learn how to use alternative techniques like pelvic blocking and activator to treat stubborn or sensitive patients.

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Crazy lookin', right? Lisa and Jack practice naso-sympatico.

My very favorite course this trimester is Hydrotherapy. If you've been reading my blog the past few weeks, you'll know that I adore this class. Last week, we practiced constitutional hydrotherapy, a vis-stimulating treatment that involves alternating hot and cold towels and applying electrical stim. Two weeks ago we experimented with Neti pots, as well as steam baths and naso-sympatico treatment for sinusitis.

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Neti Pot time! Pouring water into my nose.

Lastly, I get to spend four hours a week in the clinic, which you have also read about already if you've been following my posts. Observing allows us to focus on understanding how the clinic operates and to practice writing SOAP notes without the stress of actually having to treat patients or think really hard about the cases. I am so thankful that I get to watch and think and learn from my peers; many of the interns I shadow offer useful tips, teach me the finer points of writing a SOAP note, listen to my suggestions, and answer my questions about their patients.

Oh! How could I forget to mention my massage courses! I love the physically exhausting challenge of giving massage in my Fundamentals of Massage class every Tuesday night, and my class on Ethics and Practice Management is helping me to visualize how I will apply this skill in my practice of the future. Despite how satisfied I am with this trimester, I admit that I am already looking ahead to what comes next! I can't believe I am already halfway through medical school; time if flying. On that note, I better get to work preparing for my Phys Dx practical! Wish me luck!