Tribute to Our Greatest Teachers

Editor’s Note: Every year, first year medical students pay tribute to the individuals who donate their bodies and become some of the most important teachers in many medical students’ lives.

kisslerBy Mark Kissler, MS3

In McMillian Auditorium, the first-year lecture hall, students of medicine and nursing gathered on the evening of March 20. They came to pay their respects to the donors who had given their bodies, and by doing so, served as first and honored teachers. The lecture hall was dimmed, the mood subdued; in front, a central table stood with two large vases filled with flowers, a wish tree with tags of poems and notes, and the cremated remains of one of the donors in a simple white box. Through spoken word, music, and art, students came forward to express something of the experience that they carried with them.

First-year students organize the ceremony each year with guidance from Frank Kretzer, head of the Division of Anatomical Sciences, and Caroline Kosnik, Senior Administrative Coordinator in the Department of Molecular and Cellular Biology. Over the last seven years has become a way for the class to pause and celebrate the gift that anatomy donors have given to their education. It is a capstone to Baylor’s anatomy program, which begins on the first day of classes by emphasizing the privilege of cadaver dissection. The anatomy lab can be a challenging place, on many levels; one that pushes students into new tensions of discomfort and responsibility. All of the traditions that frame the lab—the use of professors’ first names to emphasize the teaching role of the donors, the speeches from past students and physicians at the opening of the lab, dissecting in the shadow of Tennyson’s “Crannied Wall”—show the importance that Baylor places on the culture of the lab and the way that it informs the greater culture of the school.

Participants imagined what their donors had been like in life. They expressed ways that the physical intimacy they developed over the course of the year caused them to reflect on who these people were before their bodies came to rest before them. Uncovering imbedded structures led gradually to an appreciation of persons in their wholeness.

The ceremony served as an interval, one hour set apart for recollection in the midst of busy pre-clinical education. Attendees of that evening’s ceremony left with images and perhaps new understanding of the parts that make up the whole. The hand, the face, the juxtaposition of providers’ lives and those of our patients: this is the substance of the work before us all.

Why I Choose Primary Care

Myra WongBy Myra Wong, MS4

I once took a personality test that said: “You enjoy making to-do lists. Sometimes, at the end of the day, you even add tasks you unexpectedly accomplished, just for the satisfaction of checking them off.”

Curiously, this was absolutely accurate. Being meticulous had been central to my character for as long as I could remember–as far back as little porcelain ballerinas arranged apart by the inch, teddy bears seated by “date of birth,” and picture books shelved by size (then sub-classified by author). The to-do lists which organized my life represented purpose, each day’s success measured in part by checked-off boxes.

Years later, as a medical student on clinical rotations, I began to see my check boxes everywhere: scribbled on the scrap paper of interns or on my team’s white board. Here, they stood for the evolving management plans of our patients.

One October afternoon on the wards, I was called down to the ER. There, on a stretcher, lay a man who was flushed and wincing with abdominal pain. My interview revealed him to have loose stool, poor appetite, and corticosteroid use for his recently diagnosed inflammatory bowel disease. For the next few weeks, I followed him through diagnosis of CMV colitis, treatment with IV antiviral medication, and eventual discharge. In this time, other members of my team rotated services while I continued to round at his bedside. There was something special about feeling like I knew this patient’s story more intimately than anyone else did. He acknowledged that amidst the changes, I was his one constant. He became the first patient who I truly felt was “my patient,” and who in turn saw me as “his doctor.” At discharge, I was left wondering how he would fare in the upcoming months. I learned that the check boxes – the to-do list, the “assessment and plan,”- did not end at discharge.

The ideal of continuous partnership between doctor and patient, particularly within context of the wide breadth of general medicine, led me to delve into my school’s medicine-pediatric county clinic. One day, a heavyset man came in with venous stasis ulcers on his legs. Peeling away stuck-on gauze revealed gaping craters embedded with weeping yellow tissue. “People criticize the county,” the man spoke of its health service, breaking into tears. “But it has done so much for me. You don’t know how much I appreciate what you do.” He expressed motivation to become established at the clinic. I sought to reassure him with a plan which included assignment to a primary doctor. I felt invested in his welfare, sharing in his own goals for his health.

In this clinic, physicians recalled patients’ personalities, diagnoses, and management challenges instantly upon seeing their names. A common theme ran as residency graduation approached. “I’m sorry,” the resident would say. “But as you know, I am graduating, and this will be our last visit together.” The patient would furrow her brow in dread, tears welling. However, she would then say to me with pride, “He took care of me for four years. And he is a good doctor.” That was when I decided: this is who I wanted to be for my patients.

I recognize that the practice of medicine is innately imperfect. At times unpredictable and trying, painted in human nature, it is far more complex than objectives outlined by neat little squares on a piece of paper. Yet in managing one’s health over the long term, there exists a similarly dynamic set of tasks regarding chronic disease maintenance, preventive care, and specialty care coordination. Therein lies the big picture, and the primary care provider is the curator. As fundamental as this role is, the need for primary care physicians continues to grow in the U.S.

Primary care is widely recognized as an essential tool in fixing one of the biggest problems we face today: the paradox between exorbitant health care costs and unsatisfactory health status relative to our global peers. Consider the man with cirrhosis who comes to the ER with ascites because, being “lost to follow-up,” his diuretic dosage remained unadjusted after his last hospital stay. By the same token, think of the woman who no longer needs diabetic medication due to weight loss.

Such examples of both a costly problem which could have been prevented by effective primary care and one that was solved as a result of it motivate me to enter the field. Primary care as a tool is “only as good as its user,” and its success requires committed providers and a cooperative medical community. In undertaking my part, I seek to cultivate my knowledge and skills in the next stage of my training toward becoming a proficient internist. With that, I have never been more energized to tackle this far-reaching agenda, one patient (and one check mark) at a time.

Exotic disease hits home

Lucy ZhuBy Lucy Zhu, MS2

Editor’s Note: All names have been changed and all patient identifiers have been removed from this story.

“I don’t even know what I have.”

Those were some of the first words that came out of the mouth of a 25-year-old female at the county hospital. “Amy,” as I will hereby recall, presented with fever, malaise, chills, and sweats, supposedly from an unknown cause. She had recently come back from a trip to Africa with her boyfriend. Quite the exotic romantic getaway, but the only problem was that she had neglected to take the prophylactic medications often taken before a trip to Africa.

“Several of my friends had gotten sick during the trip but I hadn’t. I thought I was fine.”

Now teary-eyed and forced to contain whatever she had with a protective breathing mask to prevent infecting other patients from her yet-to-be-determined illness, “Amy” sat down and gave me her urine sample.

I looked at her and thought about the possible things she could have. Some exotic virus from Africa; some malicious bacteria devouring her, transmitted from a fellow travel mate who had since recovered; or perhaps a particular parasite that just waited out its latent period before unleashing its wrath on this poor girl.

Normally, I would’ve done a complete work-up on “Amy” and presented her to my attending. I would have asked for cultures of her blood and urine, made a list of differential diagnoses, and discussed with my team to decide how to proceed.

However, I was not in my white coat. She was not my patient. I was merely moonlighting as an ER tech in order to earn work-study money for my rather pricey medical education training.

Despite my limited role of only drawing her blood and taking her urine sample, I thought about her case. “Amy” had not taken her anti-malarial medication, and the more I thought about it, the more it perhaps made sense. The two weeks between her initial arrival in Africa and her now-sickly appearance at a hospital more than 10,000 miles away; the elevated fevers, chills, fatigue, and sweats; her abnormal liver function test results; the no-doubt abnormal blood smear that would be taken shortly after. My guess was malaria.

And then I thought, wow. What was the likelihood that I would find this exotic of a parasite—Plasmodium falciparum (aka malaria)—so far away from its origin in Africa?

Growing up in the United States, I was shielded from many of the maladies that harm others around the world. So many countless parasites I was fortunate to never encounter; so many viruses I did not and will not be afflicted with due to vaccines; so many things I will only ever experience through a textbook in class, my biggest risk for exposure being the possibility of an unfortunate needlestick at the hospital. Yet here she was. This lady, whom in my mind I had already diagnosed with Plasmodium falciparum.

Many of us in the more privileged world do live far away from global health diseases. Many of us, less the individuals who travel to underdeveloped countries, will never see any of these diseases firsthand. Many of us, sheltered from this world where these diseases plague everyday lives, deny their importance and ignore the calamities they have caused. But the truth is, they do exist. They are very real. “Amy” and many others who are hurting and need help—we need to learn as much as we can about global health, in order to help those in need.

Patience and Patients

Editor’s note: author preferred to remain anonymous after discussing own medical history in the following post. Please feel free to direct all questions regarding the article to myself or any of the Progress Notes team. – SM

“When was the last time you saw a doctor for your diabetes?”

It was 3 o’clock on a Friday afternoon, and I was interviewing a patient. Crammed between a wall filled with bulletin boards and the patient’s bed, I stood trying to be as inconspicuous as possible. Hospital beds, doctors, and nurses blew by the door as I began a history and physical on this poor man.

His gaze slipped past me to the wall as he tried to think about the last time he had been to a doctor. After a moment he answered: “About three years ago, I think.” I felt a brief twinge of irritation at the answer, and tried to school my face into a more neutral expression. Noting that answer down, I continued on with my history taking in the chaotic hallway and soon forgot about the encounter.

Three weeks later, I sat in a doctor’s office and thought again about that patient. Why had I felt so irritated at his answer?

We are taught in medical school how important it is to control and prevent complications from chronic conditions, and it is frustrating to see what we consider to be a nonchalant attitude towards personal health. When there are no external factors limiting access, it’s seen as irresponsible when patients don’t try to keep up with their health. I maintain that being frustrated at patients when they behave so cavalierly is understandable (if not entirely desirable).

However, on a lot of levels, it is also incredibly hypocritical for a lot of us to be that frustrated.

Physicians are notorious when it comes to lack of self care. In a year and a half of medical school, I’ve had numerous lectures, seminars, and electives all promoting the value of self care. We are encouraged over and over again to take care of ourselves and to not neglect our own well being. And yet, I myself avoided getting a PCP until a health problem necessitated having one. I’m supposed to know better, and yet I still procrastinated on it. What right did I have to judge that patient?

Sitting in that doctor’s office, I reviewed my own actions. I was no better than my patient, stranded in those hectic hallways. In some ways, I was worse. I knew why I needed to go to a doctor for regular check ups. I knew what the complications of my chronic condition could be, and yet I avoided the doctor’s office as much as possible. It was poor form, frankly put.

Remembering to take care of ourselves is a tough lesson to remember sometimes, as we rush from room to room, patient to patient and get buried by work.

I sat through 18 months of lectures and reminders about the importance of self-care, but that lesson didn’t hit home for me until I met this patient. He reminded me that to become better doctors, we must first learn to be better patients.

Selected Healthy-Living Cooking Blogs

Julia WangBy Julia Wang, MS1

I came up with a short list to identify places where students can find easy, yummy and healthy recipes for busy schedules. I’ve always been convinced that cooking and knowing exactly what you are eating would help you stay healthy. Plus, you can save money by avoiding ordering delivery three nights a week.

On a daily basis, there are many things that prevent me from cooking and not having enough time is usually on the top of my list of excuses. But I found that by cooking in bulk, it actually saves me time. However, I would usually be intimidated by the long list of ingredients and paragraphs after paragraphs of instructions in a recipe. That’s why I prefer to go to food blogs with delicious photos and even videos!

Here is a glimpse at how I start cooking.

  1. Looking for recipes with minimal variety of ingredients? Martha Stewart’s Everyday Food Blog is where you can find some. It includes videos and straightforward instructions! Easy and good recipes are absolutely a godsend on weekday nights.
  2. Don’t know where to start at all? Check out foodgawker.com for potential dishes that you want to cook (i.e. saliva-inducing food). I apologize if you start feeling hungry with an empty fridge at home.
  3. I often find fancy recipes on blogs with beautiful food but simplify them and make them in bulk. Here are some tips to make food in bulk! This is KEY to how you save money and time by cooking at home.
  4. If you are in need of some entertainment, here is a series of cooking videos with a poodle narrator and a Japanese lady. To be honest, few of these recipes are practical for a student’s daily life style, but who doesn’t need animal videos in their lives?
  5. Finally, Natalie Uy, MS2, has an awesome food blog called Obsessive Cooking Disorder with an amazing variety of recipes and frequent updates.  (She shows us that it CAN indeed be done. But how does she do it??)

Tell Me What You Really Think

Stephen ManningBy Stephen Manning, MS2

“No teacher has ever told me what they really thought of me.”

That’s what I was thinking as I read the evaluations that were written about me during my pediatrics rotation.

The judgment of my previous successes and failures in my pre-medical career had always been masked by the convenient A’s and B’s of report cards and progress reports. There was no context, sub context, or innuendo. Just letters.

Well, except for “works well with others” and “penmanship needs work” in kindergarten.

But to have those letters A through F, or in this case numbers 9 through 1, accompanied by praise and criticism? It’s like if Bill O’Reilly and John Stewart were judges for Olympic figure skating. The FOX News host would castigate the skater for twizzling in his no spin zone, while John would do an impression of his grandmother to convey his extreme disappointment.

In total, I’ve personally received six evaluations from residents and faculty. They’ve ranged from glowing to incendiary, all containing the same underlying theme: “Stephen is hard-working and cares immensely for his patients, but has a lot to learn”

In short: you obviously care about this, but you’re not that good… Yet.

In reviewing these comments, it became apparent that the varying numerical responses to my performance were a matter of subjectivity and perspective. Suddenly, I found myself at the mercy of the Olympic panel in the category of “presenting the patient”. One judge holds up a teeth-gnashing “3″ for my inability to gracefully present a patient, while another counters with a “9″ for my ability to smile while humiliating myself.

So which number should I be more excited about? Most would probably say the 9, as it validates our presence in this career path. “You are great, Stephen. Keep it up”. But not me. I’ll take the “3″ and the gnashing of teeth any day.

Because, like I said, no one has ever told me what they really think about me in a professional setting. Tell me that my shaking voice betrays just how nervous I am during morning rounds, or that I have an elementary understanding of the pathophysiology of RSV bronchiolitis.

That way, when I’m treating a kid with that condition ten years from now, my caring disposition will be backed by a wealth of medical knowledge and experience.

In that moment, the scorecards and comments will all take a backseat to the care of my patient – even Olympic judges can agree on that.

VIDEO: Match Day 2014 is here!

Donna Huang, Chaya Murali and Jupin Malhi
Donna Huang, Chaya Murali and Jupin Malhi

After counting down the hours, the day has finally come! Today, MS4s across the country met their match: they learned where they would be going for residency, the next phase of their medical careers. Here at Baylor College of Medicine, MS4s enjoyed a brunch on campus with their families and friends, then anxiously waited in the courtyard until 11 a.m. At that time, the butcher paper was ripped off the Match Day board and the MS4s rushed forward to find their envelopes, pinned to the board in alphabetical order. Inside, they found the final verdict: where they would train for the next 1 to 7 years. Wondering what happened to our three student writers? Watch the video below to find out!