>November 07 2001

>Today was almost a free day. We had a Biochemistry test at 9:00 and a break from our normal Wednesday afternoon Case Study session. That meant I got to go home when I finished my test at 10:30! Once again, I did not feel great about my test. I still have not been able to jam on a Biochem test since I made an A on the first one. I am getting frustrated with not doing as well as I want. I went into my bunker mentality and started getting organized for the next test as soon as I got home. I like to build a spreadsheet with all the lecture topics and assigned readings for the next exam block. For our fifth Biochem test (which won’t be for four weeks due to Veteran’s Day and Thanksgiving holidays!) we have material from 20 lecture hours and 3 two hour long case studies. I like to try to get everything laid out before me so I can see the big picture before we dive in. I think one of the weaknesses in this class is that there doesn’t seem to be a coherent view of where we are going. There are seven different professors who give the lectures and they each speak on their individual topics but nothing seems to tie them together for me. It just seems like a mish mash of material. I go through this after each test. I get all fired up about how I will be the MASTER of Oxidative Phosphorylation Reactions in the Mitochondria. I review the class notes as soon as they come out and do all my readings for a couple of days, but then the fear of the next Amatomy test descends upon me and I neglect Biochemistry until I realize that I cannot be the master of it. I then shoot for being proficient. Then comes the stage where I just hope to have a vague concept of some parts of it. But this time I really will do better!
For many people in medical school, this is the first time in their life they have failed an exam. It really gets to some of them. I cannot say that I’ve never failed a test before but I do think that I can say that I had never failed a test that I actually studied for until this year. Not that I am making a habit of failing … I just am not doing as well as I am used to.
We had a great Clinical Correlation lecture in Anatomy yesterday. Dr. Galli of the UMC Emergency Medicine department spoke to us about emergency procedures. If you watch E.R. on TV, this was your guy. He had worked in Los Angeles before coming here and actually had given war stories to some of the producers of the show to aid them in storylines.
He opened the class by telling us what many of my classmates are starting to suspect, “your first two years of medical school are all bullshit.” This prompted a spirited round of applause and hoots, much to the chagrin of our professors. He told us that all of the details we were learning would soon be forgotten but did concede that a few of the biggies would stick. He then told us that despite all that we should be busting our chops to get all this stuff, not because we would need it as doctors, but because it was important to have good marks when our residency applications came up in a few years.
Then we jumped right into how to give a choking person a tracheotomy. You can do it with a pocket knife and a ball point pen if need be. He made it look so easy, I really think I could do one if necessary. We saw all kinds of gory photos of stab wounds and botched suicide attempts. Perhaps the most interesting procedure Dr. Galli showed us was “cracking somebody’s chest.” In the case of a penetrating wound to the heart, such as from a knife or bullet, the patient may be bleeding into the pericardial sack which surrounds the heart. The heart, though damaged, is still pumping enough blood to keep the patient alive. However too much bleeding into the pericardium can build up pressure and compress the heart enough to interrupt circulation. In a case like this you have just a minute or two to get inside the thorax and cut the pericardium open to allow the blood to escape. To get in, you have to be “fairly aggressive and fast.” You make an incision between a pair of ribs and even crack a few of them open if need be, to access the pericardium and cut it open. You may also need to manually massage the heart at this point to restore a heartbeat. Of course while you are being aggressive, you must avoid cutting a lung open or severing the phrenic nerve to the diaphragm, without which you can’t breathe.
He was a great speaker and cracked jokes while showing us these photos. I would guess that being able to laugh at this kind of stuff is necessary to be able to stay in his kind of work. He claims that all of us will be able to do stuff like this even if we don’t go into emergency medicine. I was kind of horrified at the thought. Not because I am squeamish about the blood and gore, but because of the split second decision you must make about what needs to be done. I can’t imagine cracking someone’s chest open and then discovering that the heart is not damaged after all. Of course he told us that in those particular situations, the patient is probably dead already and you’re just trying to pull a rabbit out of the hat.
He ended by encouraging all of us to come to the ER and hang out when we had time. If we wear our white coat, they will hook us up with the resident on duty and let us observe and maybe even “actually touch a patient!” He told us that Friday and Saturday night are the best times to come because you will see more cool stuff. I think the next time I am having a slow weekend, I may take him up on it!

About Marcus Lee

Child Neurologist
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