Most med schools, I've heard, don't have a 5th semester. What I mean to say, is that they have no transitional semester - they dump you right into your clinical years directly following basic sciences. I'm all for the way Ross does it - I've heard that our students shine as beacons of clinical know-how among these US med students, and I guess this is the reason. For in this 5th semester, we're learning to be available at all hours, busy every single day of the week, and accommodating of schedules that are only finalized days before indispensable events. All sarcasm aside, they're holding us by the hand, and leading us from station to station, showing us what's expected of us, while giving us tons of help. Granted, this is all in favor of increasing their bottom line - but it's in my best interest, so I can't complain.
Remember that patient I went to see? The write-up (Doc-Jargon-translation: H&P) was due sometime Tuesday last week, and I've got to say we were lucky - first of all, having it due earlier in the week freed up a lot of time, and minimized conflicts. For example, I didn't have to follow a sleepless night (redolent of undergrad), spent feverishly revising and re-rechecking my paper with a 12-hour shift in the ER. It was nice to get it out of the way - I still don't know how it went, but at least it's over, and it sort of got me back into the study mindset.
Another part of their getting us ready for stuff is making sure that we're certified to be more than just in the way in the event we're in a hospital and something actually happens. 2 weeks ago, we went through our ACLS/BLS certification. I may not have all of the drugs down completely (amiodarone/adenosine/atropine), but I have some idea of what oughta be down. I can give CPR now, and perhaps even keep someone alive - I may in fact be legally obligated to stop and help if there was some emergency - which I'd do anyway.
The second part of that certification - BTLS -was much more fun. It started off with a rather uncomfortable discussion about domestic violence and violence against women in general. I suppose it's important to be aware of all the possible psychosocial situations surrounding our patients.... Anyway...we started off learning how to scrub in for surgery. To hear it told, surgeons are the dragons of the hospitals (and, according to today's personality disorder lecture, all narcissists), thus it is of the utmost importance that, if we are allowed the honor of watching a surgery, we be immaculately and aseptically prepared, lest we incur their wrath or - heaven forbid - the ire of the head OR nurse. I may be leaning a bit more towards surgery with every passing day (keep in mind my.....25 year absence from any OR...), so it was nice to finally learn how to do it.
After that came the fun stuff. I'd done suture clinics on the island, so wielding forceps and a hemostat was no strange chore; it was made especially easy since we stuck to interrupted stitches. They're easy enough to do, and they're you basic closure of a skin incision - unless we're talking plastics, in which case you don't want the scars to be seen, and will go for some skin glue or subcuticular stitches (my personal favorite.....of the three that I know....and have never done on any living person...). We used pigskin this time as opposed to the fixed flesh of generous people who willed their bodies to science - because, apparently, pigs are so similar to us in constitution. Next came the IV and shot-giving station. Not a whole lot new here - I'd never given shots before, but I've plunged enough razor sharp needles into veins to have some idea of what I'm doing. All of this paled in comparison to the IO needles.
IO (intra-ossesous) needles are generally employed in the event that an IV can't be established within 90 seconds, and, at its crudest iteration, looks like nothing short of pre-Roman torture. The whole point, though, before I get into the gory details, is that you need to give a patient medicine, or they'll die - and so, veins failing, you go straight to the marrow. These needles pierce the outer layers of the bone (most commonly the flat part of the tibia), establishing a site for the infusion of medications. The one they told us the Army used way back when looked a lot like a corkscrew and worked exactly the same - you pressed it against the skin, and use a corkscrew motion to drive the needle and sheath down through the skin, coring away the subcutaneous tissue as you drove this little steel spike down through flesh and blood, piercing the bone until you reached the center. Others weren't so bad; there was a little gun-typed-device, which you could load and shot directly into the bone. There's also a drill - quite literally, just like one you'd pick up from the hardware store, though without the bells and whistles. And you'd drill into the bone. We practiced on the drumsticks of chickens, and successful procedures were marked by an audible *POP* as the periosteum gave way, as well as the sudden disappearance of resistance once you hit the bone marrow. Very, very nice.
After that came a station about the proper insertion of foley catheters, birthing basics, and backboarding. Do doctors do all of this stuff? Not really. But I'm a long way from there, and, like I said, if ever I find myself in the middle of a code, or some other unforseeable emergency, I'll actually be able to help someone.
Another thing Ross is doing for us this 5th semester is sponsoring a medical Spanish class. I may work as a TA, I may not - I don't know yet. I do, however, know that, if our professor wants anyone to come up and sing and dance in front of the class in order to help everyone learn the parts of the body, she can count on me. Again.
No comments:
Post a Comment