The Bat Cave

Believe it or not, I found myself with a little bit of free time at the start of our anatomy course. Because I had taken human anatomy while at Ohio State, I have been spared some of the necessary hours it takes to memorize muscles, bones, nerves, vessels, and other tissues that constitute our bodies.

On our weekly student opportunities email, I saw a posting for a two-week part time research position gathering articles, and I jumped at the chance to do something productive and earn a little extra cash. The task was to gather copies of pre-identified journal articles studying the global burden of certain diseases among children.

Not a tough job except that the list included over four hundred articles going as far back as the 1960s. Working with a fellow medical student, we split up the list to search for them one by one in the medical school library's catalog. Many of the articles were easily obtained online, but just as many of them were only found in the serial (bound journal) collection in the physical library. For these, we had to descend to the level L2 at the Count. Dun dun dun.

Countway Staircase- from Harvard Gazette

The Countway Library is also home to the Boston Medical Library and one of the largest collections of medical information in the world. L2, the second basement level, is home to the section of all hard-copy journals published before 1986. It actually stretches underground to be about double the size of the building above ground, and it is filled to the brim with rows and rows of journal issues, some of which date back to the early 19th century.

As part of the work, I winded in and out of these aisles looking for issues from journals such as Acta geneticae medicae et gemellologiae, Hiroshima Journal of Medical Science, Medical Journal of Australia, and Monatsschrift für Kinderheilkunde. As you can imagine, it wasn't my job to actually translate these articles.

Perusing these journals, I was struck by the perponderance of ads for perscription drugs and medical devices whether in Germay, the United States, or South Africa or during the 60s or the 00s. Not only does the bat cave document the research literature, it is a store of information about the influence of the pharmaceutical industry in medical research and health care worldwide. For better or worse, they have shaped the development and implementation of medical discoveries for decades. The heart of evil or the caped crusader?

Death and All His Friends

Lake Edward, Uganda, December 2007

It's hard to believe that we have been in class for over two months now. As we have progressed in our coursework in the lecture hall and our weekly workshop in the hospitals, I still think about some of the issues we discussed during our introductory course, most notably how to deal with death.

The professor in our first class reflected on the subject of death on the afternoon of the very first day of medical school. As a primary care physician, she spoke about her experiences of treating a patient and his family until there was nothing left to treat except to make his death as comfortable and dignified as possible. She used the story to illustrate that although the profession of medicine is not solely focused on death and dying, it is an inalienable part of working with the sick and their families.

This reality has played out in small parts in the last two months. Through our biochemistry class and patient-doctor class, we have interacted with a few terminally ill patients. Also, a couple weeks ago, I posted this article written by a woman who described caring for her father in his last weeks and hours of life, and how we as a society need to speak more openly about death.

In these shallow dips into the realm of mortality, I can't help that feel that out of all my life experiences prior to entering medical school, nothing has really prepared me for this responsibility. How do I and my fellow physicians in training comfort a patient when he is facing what could be the last stage of his pancreatic cancer or the lady whose severe diabetes will inevitably lead to a fatal stroke or other complication? Or more broadly, how does a physician get to the point where these conversations, although not prosaic, become part of the ritual at work?

One challenge about medical school is that there is little time to sit back and reflect. At the start of our anatomy course, we were fortunate to attend a talk by physician-author Pauline Chen, who wrote the book Final Exam. She read some fine passages which described her own evolution as a medical student and resident, particularly with respect to how she came to be able to stay with families through a patient's death. She reminded us that one of the most important things we can do is to remember the people who we are now, at the beginning of our training. Check.

PS> The title of this entry is from my favorite track on Coldplay's most recent record.

Docs on the Interwebs

With MCM behind us, we've embarked on the Human Body block. This course incorporates gross anatomy (dissection of cadavers) with histology (study of human tissue) and embryology (study of development of the embryo in the womb). It is a significant transition, and the pace of classes seems to be accelerating. On Tuesday, we received our cadavers that we, working in groups of four, will be dissecting for the next two months. I am still coming to terms with this new responsibility, and I will try to write about it soon.

As I continue working on entries, I want to direct you to some of the many medical blogs I've stumbled upon on the world wide web. I was surprised by the sheer number of them written by physicians, nurses, and other health care providers, and how many of them are part of a community that collaborates, argues, and pokes fun at each other while accounting the challenges and successes of being in the medical profession. I can only hope to write as well and often as they do.

• Apollo, M.D.: Tales and thoughts from a third-year medical student
• Edwinleap.com: A ER doc and columnist from SC
• Crass-pollination: Stories from an ER nurse with a biting lip
• Running a Hospital: Written by the CEO of the hospital just down the street, and also a vast array of links to other medical blogs
  

Happy October

Yes, it is my birthday, and yes, my recent time has been consumed by Spore and studying for the final exam in Molecular and Cellular Basis of Medicine, which means studying lots of complex enzymes, pathways, and acronyms while using a computer game to create and evolve creatures in complete contradiction to the rules of nature and molecular and cellular biology. Ironic? Probably.

On the plus side, I am heading to New York this weekend!

No, I am not trying to neglect the blog--I am trying to write content that is useful and memorable. Some entries in the works that may or may not come to fruition:

• Docs on the Interwebs
• Death and All His Friends
• MFO's
• Healthcare for All
• The Origin of Weird Disease Names