My First H&P

January 20, 2010

I just peeled myself off the couch to come update the blog.  I was reading about metabolic alkalosis (when your blood becomes basic due to metabolic imbalance).   It is already my third week of second semester and the academic work goes along as usual: lectures, reading, diagrams, note-cards, and trying to get enough sleep.  The lecture-hours to organ-size ratio is extremely high right now.  Kidneys do a LOT- those busy little beans!  (Just checked, and the next unit is the lungs which only lasts 2 weeks for comparison.)

Last Wednesday I began my weekly hospital rotation for Physical Diagnosis II, and I felt the happiest that I’ve been in a long time.  In fact, I had such a good time that waking up early and commuting 1.5 hours each way felt negligible.  The first day was mainly an introduction, but I already fell in love with the doctors and hospital.

I can’t wait to see my first patient there tomorrow.  I just gathered all my medical equipment in a small pile (I really need to get some kind of doctor bag).  Tomorrow I’ll have lecture in the morning, then 2 hours to take a history and physical exam with a patient (who could be a child or an adult from almost any department).

The big change from anything I’ve done before is that I’ll be responsible for writing my own notes.  Doctor’s notes are referred to as “the H&P” which stands for “History & Physical  (Examination).”  Not “H&PE!”  That would be TOO obvious.  Sorry, but abbreviations in doctor-world don’t make much sense to me yet!

We had a sample H&P due this past week.  The assignment was based on a staged appointment with a standardized patient actor who had chest pressure.  It took me about 3.5 hours to finish it!  I can hardly imagine that eventually it should be possible to write my notes in 10 minutes or less.  There’s going to be a steep learning curve (this along with everything else of course).

The main reason why it feels so hard is that I’m not used to the proper formula.  Much like a lab report, an H&P is a scientific report that has sections for specific information.  I’m learning that a good H&P will be as objective as possible .  That means rather than using phrases like “normal,” “as expected,” or “acceptable,” I need to actually DESCRIBE what I did or observed.

I struggled with descriptive phrasing, and I’m sure someday I’ll be rolling on the floor laughing at what I wrote.   ”Hears fingers rubbing in both ears.”  ”Warm and dry, fingers pink.”  ”Symmetric head, no wasting of facial muscles.”  ”Tongue in midline.”  Well, I have to start somewhere.

And tomorrow is the real start to seeing patients and performing focussed physical exams.  I’m so excited!  Oh yes, THIS is the reason I came to medical school; to be present with people.  Now back to metabolic alkalosis…

6 Comments | Medical Procedures, Medical School Life | Permalink
Posted by Liz

ALS: Tim’s Disease

January 12, 2010

This week I learned that a college classmate was recently diagnosed with ALS or Lou Gehrig’s disease. I was shocked because he is only 30. I never knew ALS could affect people my age, but apparently he has a genetically-linked variant that has something to do with a mutated superoxide dismutase 1 enzyme. The human body is so complex, there are endless possibilities for disease, but the rare variations never cease to jolt me.

Along with the initial shock, I thought “Why Tim?” He is such a lovable and wonderful person– a musician who plays in a band. At least two close friends of mine (and probably more like half the girls on campus) had HUGE crushes on him. Now he’s newly married to a wonderful woman who is committed to staying with him throughout his illness. I didn’t know him too deeply myself, but he stood out in many positive ways. He even has a tattoo from a Quaker song book. I would never have imagined that he would be struggling with a degenerative illness so soon.

While I was in the Dominican Republic last summer (and actually had time for personal reading) I read Tuesdays With Morrie.  This is a poignant book written about a Brandeis professor who is dying from ALS. I highly recommend it. I learned that one of the doctors who was volunteering with me had a father who died from ALS too. His dad was diagnosed with ALS right before he took his Step 1 Board exam in medical school (awful timing for a future doctor).

I learned about ALS in my neurology class this fall- I learned the medical facts, that is. It sounded like one of the worst neurological diseases, not simply because it is currently a death sentence. Mainly it is terrible because a person’s body changes without the mind. In other words, ALS (like Huntington’s Disease, “Locked-In” Syndrome, or spinal injury) causes loss of body function while the mind stays completely intact.

Of course, exceptional people who are surrounded by love have an amazing capacity to cope with mental and physical suffering that disease brings. The dry facts about any disease can’t come near to the more complete knowledge of a person with the disease. They can’t begin to explain how people feel or cope.

One of my greatest life lessons of the past 10 years has been accepting mortality and tragedy.  Understanding the reality of so many bad things that can happen at any moment makes me feel scared and vulnerable.  Yet, it helps me to challenge myself, and avoid making many decisions based on unrecognized fear.  Perhaps one of the greatest lessons in medicine is not only accepting the diseases, but actually knowing the people who have them too. This next life lesson is why I am so excited about beginning my clinical rotations this Wednesday.

After this week ALS will not be just “ALS” anymore. ALS will be Tim’s disease. I won’t forget it because I can see him alongside his wife. If I see anybody with unexplained neurological weakness, ALS will be whispering in my ear and begging to see a neurologist. Thanks to Tim’s friends and modern technology, I’ll remember his experience on video, and most importantly, his story will live with me forever.

1 Comment | Death, Diseases, Patients | Permalink
Posted by Liz

Back to School

January 4, 2010

Christmas break is over, and it’s 2010 already.  I am trying to decide if I’m ready to wake up at 6:30am tomorrow and head out through the snow to sit through 4 hours of kidney lectures.  I guess I am!

One thing I am looking forward to this semester is getting to spend all day every Wednesday with patients.  For our “Physical Diagnosis” class, we’ll be going to different area hospitals to learn from clinicians, and see patients on our own from different departments.  My partner and I got a terrible lottery number (all placements are based on random lottery numbers to help us prepare for the residency “match”).  So, my partner and I are assigned to a hospital 90 minutes away.  The good news is that the school provides a van, but the bad news is that I’ll have to leave my house early to commute to school to catch the van.  Wednesdays will be long, but nevertheless I can’t wait for a whole day of clinical learning.

I’m sure the rest of the semester will go by in a flash.  We’ll continue studying pathophysiology by organ group- kidneys (renal), lungs (pulmonary), heart (cardiovascular), gastrointestinal (GI), spring break (my first time to mexico!), hormones (endocrine), pregnancy and babies (reproductive and embryology), and finally the Board Exam (yikes).  I just set my exam date for June 5th, but it still seems too far away to be real.  So in brief… lectures, studying, exams and maybe a little fun too.  Here goes!

1 Comment | Medical School Life | Permalink
Posted by Liz