My Month in the Forbidden Corridor: Or, The Psychiatry Peril, Part 1

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”And finally, I must tell you that this year, the third-floor corridor on the right-hand side is out of bounds to everyone who does not wish to die a very painful death.”

– Professor Dumbledore, Harry Potter and the Sorcerer’s Stone

As the night-shift nurses came on duty, Harry reached across the table and shoved a handful of cinnamon pita chips into his mouth. Then he reached for another handful. And another.

“Please, help yourself,” said a nurse named Elvendork, sliding the tray of hummus in Harry’s direction.

Harry swallowed the globule of starch at the back of his throat. His mouth was still dry, and translucent flakes of skin stuck to the back of his hand as he wiped his lips.

“Thanks, Elvendork,” said Harry, “but I should probably be heading to the patient intake office. I’m on call tonight.”

Elvendork glanced at the clock on the wall. “You’re right, you should get going. Have fun!”

Fun wasn’t exactly the word that came to mind as Harry mentally mapped out his route through the belly of the inner-city hospital to the depths of the inpatient psych unit. He swallowed another handful of chips, swung his laptop bag over his shoulder, and descended into the stairwell.

***

tapestry_corridor

How can you describe the dusky hallways of a hospital after hours? Signs on the walls are as ambiguous as they ever were, and you stumble in the path of the arrows until you reach either a dead end, a unit closed for construction, or a deserted reception area. Motion-sensing fluorescent lights flicker on and off as you ponder which turns to take. The empty chairs and patient exam rooms taunt you as you swipe your badge to open one door after another, venturing deeper and deeper into catacombs of silence. And finally, when you accept that you’re in the wrong wing of the hospital altogether, you make a complete 360-degree turn and try to recall which of the five identical doorways you entered through several seconds ago. Not a voice, not a whisper, not a flushing toilet disrupts your solitude. You pull out your phone to text a coworker for help, and the lock screen spells out “No Service” in the upper left corner.

***

Flashback to six months ago

Harry was on his surgery clerkship, and he was late to the OR in an unfamiliar hospital. He tried taking a shortcut to the 2nd floor via an elevator hidden behind a barricade of vending machines.

Once on the second floor, Harry realized with an escalating feeling of dread that he had never seen this hallway before in his life. Unlike the other hallways in this hospital, this one was only a hundred feet long, with doors made of steel on either side. (It also reminded him of a prison he had seen on TV, but that wasn’t a unique characteristic, by any means.) Harry took a deep breath and turned back to the door through which he had just entered. It was locked. He tapped his ID badge against the panel on the wall, which only flashed red back at him.

Harry had no choice. He peered through the window in the door and waved frantically at a nursing assistant who was passing by.

“HELP! LET ME OUT! I’M NOT SUPPOSED TO BE HERE! HELP!”

After some time, a housekeeping staff member took pity on Harry and escorted him to the nurses’ station of the adult inpatient psych unit.

“Excuse me, sir,” said the charge nurse, “but this unit is confidential. You’re not authorized to be here.”

“I promise I won’t come here ever again,” said Harry, clutching his chest. “Just let me out of here, please!” He would have dropped to his knees and begged if circumstances had called for it.

***

Harry arrived at the intake office of the psych unit 45 minutes late. As it turned out, the first floor was under construction, and the office had been relocated from the first floor to the seventh floor.

As Harry dropped his bag on the sofa, a shadowy figure came looming out of the gloom of the foyer. It stooped underneath the doorframe, lumbered past the coat rack, and collapsed in the office chair next to the window. Underneath its weight, the back of the chair slumped backward until it lay parallel to the linoleum floor.

“Sorry to keep yeh waitin’, bit of an int’restin’ circumstance downstairs, yer friend Ron is takin’ care of it for now.” Dr. Hagrid, the psychiatrist on call, smiled at Harry in between his labored breaths. “Are yeh ready?”

“Er – “ started Harry, but Dr. Hagrid had already commenced his speech.

“Now, listen carefully, ‘cause it’s dangerous what we’re gonna do tonight, and I don’ want yeh takin’ risks. First of all, always take the elevators, sometimes the psych patients manage ter escape from the locked unit, and no one will hear yeh scream in the stairwell. Second, don’ wear any scarves or lanyards ‘round yer neck, they can be used to choke yeh if yeh’re caught unawares. Even that – “ Dr. Hagrid pointed at Harry’s ID holder, which featured a retractable nylon cord for ease of badge-swiping – “can be easily yanked an’ wrapped around yer neck by an experienced patient, so yeh’re better off stickin’ it in yer pocket for safekeeping…”

Harry’s eyes drifted toward the windows, which were glazed over to insulate the psych unit from the outside world. He took a moment to question the predicament he had gotten himself into, and then he focused on the next tidbit from Dr. Hagrid’s arsenal of wisdom.

To be continued in Part 2

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My Month in the Forbidden Corridor: Or, The Psychiatry Peril, Part 2

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While Harry received his safety briefing upstairs, Ron walked around the loop of the adult psych unit in search of a particular patient. Ten minutes ago, he had spotted a streak of red dashing past him in the opposite direction, and there had been no sign of her since.

He found the patient in the activity room, pulling paper towels out of the dispenser. Her hands moved like the blades of an electric ceiling fan.

“One-two-three-four-five-six-seven – ” She spoke so fast that the consonants blended together, and she paused only to glance over her shoulder at Ron. “Who’re you? Eight-nine-ten-eleven-twelve-thirteen-fourteen – ”

“Hello, there, Ms. Jones!” said Ron. “I’m the medical student. My name’s Ron. The doctor asked me to come and say hello.”

“– forty-nine fifty fifty-one fifty-two fifty-three fifty-four my shoes are white and your coat is bright, balloon baltic baby birthday banana Santa Ana – ”

“Um, right,” said Ron. “It’s very nice to meet you.”

“Bandana bonanza – how old’re you?

“I’m twenty-two,” said Ron as he took a seat at the table next to the paper towel dispenser. He felt as if his brain had just been centrifuged.

“Oh yeah, and the speed limit on the highway is fifty-five! Chives St. Ives hives and broken eyes – ”

“Ms. Jones, why don’t we throw some of these paper towels away?” Ron scooped up most of the paper towels from the table and stepped toward the garbage bin by the doorway. He smiled as the patient followed behind him with the remainder of the towels, all of which landed squarely in the bin.

“Good job, Ms. Jones!” said Ron.

“Paper packet jacket – ” The patient lifted her sweatshirt over her shoulders and dropped it in the bin with the paper towels, but Ron reached down and handed it back to her.

“I think you need that to keep warm – er – ” Ron shrugged as the patient left her sweatshirt hanging by its hood from the hand sanitizer dispenser. She stepped outside into the hallway, and Ron followed.

“Would you like to go for a walk?” asked Ron. “I need to ask you a few – ”

“I’ll leave my jacket, yes,” said the patient, “And I’m wearing this shirt – “ The patient tugged at her T-shirt – “and this shirt – ” The patient lifted the first T-shirt to reveal another underneath – “and this shirt, and this shirt, and this shirt, and underneath’s my belly button, and my pants– ”

With that, the patient loosened the drawstrings of her paper scrub pants, and tugged at her conglomeration of T-shirts as if she was about to fling them over her head in one swift movement.

“No, Ms. Jones, I don’t think – ” Ron found his voice reaching a higher pitch than he had known was possible – “not out in the hallway – ”

***

Harry was lost again.

This time, he was stranded in the pediatric psych unit. The walls were painted with psychedelic rings of yellow, turquoise, and neon pink. The ceilings glowed with a dim red light that revealed only the space within five feet of a locked door. Further than five feet, among the twists and turns and secret elevator shafts of the psych hospital, everything was shrouded in darkness. Forget the Forbidden Forest at Hogwarts School of Witchcraft and Wizardry; Harry thought, with a wry smile, that his new workplace resembled the spiders’ lair from the forest of Mirkwood, in the realm of Middle-earth. He half-expected a horde of oversized arachnids to scuttle out of the shadows and spin him into a web.

mirkwood

Rounding the corner, Harry found a nurse sitting on a chair beside a keypad on the wall. He breathed a sigh of relief.

“Excuse me, ma’am,” said Harry, “Do you know where I could find – ”

Harry turned in time to see a dark figure hurtling toward him from the side. He sprung back against the opposite wall.

“ARRRRGGGHH!!! YOU FESTERING FURUNCLE!!!”

The dark figure slammed his face against the glass window of the door, took a few steps backward, and charged toward the door again. The entire hallway pulsed with shockwaves of electricity, and the overhead lights flickered off as the figure pounded his fists against the hinges.

BOOM. “YOU CARNAL CARBUNCLE!” BOOM. “YOU GNASHABLE GNOZZLE!”

“Thanks for coming so quickly,” said the nurse, wiping sweat off her brow. She had to raise her voice to be heard against the background disturbance.  “Mr. Wood here tried to break into the stairwell. I wrote down the start times for restraint and seclusion so you can add them to his chart.”

After Harry had gathered the necessary information, he peered around the corner into one of the unused seclusion areas, a locked room seven by eleven feet in size. The walls and floor were bare except for a series of jagged, faded markings around the corner from the door. It looked as if the housekeeping staff had tried to scrub off the permanent ink, but had not done a perfect job of it. Harry pressed his forehead against the window to read the letters in the dim red glow:

**** THIS PLACE

“Holy ****,” Harry whispered underneath his breath. A shiver ran down the back of his neck. He staggered in the direction of the nearest elevator (or so he hoped), glancing over his shoulder as he went.

***

In the calm of pre-dawn, Ron and Hermione sat in the on-call room with their textbooks and diagnostic manuals spread across the floor. Dr. Hagrid had dismissed them both ages ago, but they were waiting for Harry to return from an assignment. Fortunately for Ron, Hermione was not one to waste an opportunity for a round of Interrogation, Psychiatry Edition; after all, they both needed to prepare for their exam in two days.

“What is the name of the sensory distortion commonly associated with LSD and other illegal hallucinogens?” asked Hermione.

“Synesthesias, such as seeing music and tasting color,” Ron recited.

“Electrolyte abnormality associated with ecstasy and eve intoxication?”

“Overhydration leading to hyponatremia.”

“Describe the overdose effects of K2 and Black Mamba.”

Ron blinked. “Um – what?”

Hermione sighed. “Some experiential learning would do wonders for your mastery of this chapter, Ron. All right then, describe the packaging of Spice Diamond and Yucatan Fire.”

“Hermione,” Ron spluttered, “these new synthetic street drugs aren’t in the textbook! Where’d you even find out about – wait – Hermione –

***

On the last day of their psychiatry rotation, Hermione added finishing touches to her History and Physical note for her newest patient. She had struggled to recall the names of several designer street drugs; she made a mental note to check her professor’s PowerPoint slides from yesterday.

In all seriousness, after a month of psychiatry training, Hermione felt dazed. Some nights, she struggled to fall asleep among the bombardment of images: patients screaming obscenities at the doctors and hurling their fists against walls, children crying and covering their faces when they were asked if they wanted to go home. Even when Hermione did fall asleep, she would wake up feeling as if she had been up all night, with all the vestiges of her unpleasant dreams just beyond her grasp. Her youngest patients had the worst stories, the kind that left extended-release capsules of nausea seeping into her chest for days. Her soul ached for them. She wished that she could have done more.

That afternoon, Hermione went around the hallways of the adult unit to say goodbye to her patients. She found one of them, a woman in her eighties, reading a psalm in the activity room after a music therapy session.

“You’re leaving? So soon?” The patient sighed. “Please keep me in your prayers.”

“Of course,” said Hermione. “And keep me in yours.”

“Tell me your name again. Miss Herm – ”

“Hermione, “ said Hermione, straightening her ID badge.

The patient smiled. “I’ll remember you as Maria.”

And then, before Hermione could react, the patient threw her arms around Hermione’s shoulders. They stood together for a long time. When they parted, Hermione could feel tears soaking into the sleeve of her white coat.

Eeyore Syndrome

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One morning, Ron was running late to clinic. He tossed some muffins into his white coat pockets, clipped his badge to his collar, and thundered down the stairwell at the back of the building.

Until that moment, it was a morning like any other. As soon as he walked out the doors of his dormitory, however, Ron sensed that something was very wrong.

Suspended from the clouds above, swaths of gray shadows lay draped over the turrets and clock towers of the hospital campus. As he willed his arms and legs to move, a clammy haze clung to Ron’s skin like soiled Saran wrap. Passersby on the sidewalk spoke in hushed whispers, hunched over each other’s shoulders with facial expressions reminiscent of freshly-bathed housecats. Ron blinked rapidly in an effort to convince himself that he was imagining things – this was just a typical overcast day, the sticky film around his neck came from yesterday’s laundry he was wearing today, those people over there were grouchy about the fact that Friday was two days away – but none of his theories explained the overpowering atmosphere of dread.

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As Ron strolled through the employee entrance of the clinic, one of the nurses turned from her chair at the computer station.

“Good morning!” greeted the nurse with a smile. Within a half-second, however, the nurse’s shoulders slumped, and her vocal pitch dropped by an octave. “Well, actually, it’s not a good morning, but still.”

In the break room, Ron found all of the nurses stuffing their mouths with baked goods: oatmeal raisin cookies and blueberry donuts, chocolate wafers and Animal Cookies for People.

“Ron, dear.” Ms. Hooch called from the counter with her spatula in hand. “You’re welcome to some fresh cake, if you like.”

“What is it?” asked Ron.

“Commiseration Carrot Cake,” said Ms. Hooch. She paused to breathe out a deep sigh. “Mafalda baked it this morning.”

“That’s right!” exclaimed Ms. Hophirk through a mouthful of treats, all the while gesturing with her arms like flapping cockroach wings. “That will show them, the ignorant fools! Let them eat cake!”

Back in the office, deafening sighs reverberated throughout the walls at a steady rate of ten beats per minute. Ron’s neighbor, Ms. Sprout, was a sweet lady in her early sixties who enjoyed babysitting patients’ children and passing out cookies on rainy days; today, however, she was also the loudest and steadiest sigher of them all.

“Are you okay?” Ron asked as Ms. Sprout expired a particularly melancholy breath of air.

Ms. Sprout grimaced at the computer screen. “I just woke up feeling… crappy.”

“Well,” said Ron, trying to conceal a smirk, “The weather is quite crappy today.”

“Not the weather,” said Ms. Sprout, sighing two seconds ahead of schedule. “It’s that.

“Oh, yes, that thing.” Ron grinned at Ms. Sprout. “But at least the sun rose in the morning.” He glanced over his shoulder at the nearest window. “Well, sort of.”

Ms. Sprout burrowed her fingers into her hair and let out a deep, protracted groan. Ron looked up from his patient’s chart to smile kindly at his neighbor.

“It looks like a severe subtype of Eeyore Syndrome has spread rampant throughout the campus overnight,” he said.

eeyore_worse

Ms. Sprout snorted into her coffee. “I guess you could say that. But I would much rather feel like that bouncing character– what’s his name? Tigger?”

“What a great idea!” said Ron. He wasted no time before breaking spontaneously into song.

“The wonderful thing about TIGGERS!

is Tiggers are wonderful THINGS!

Their tops are made out of rubber!

Their bottoms are made out of springs!

They’re bouncy trouncy flouncy pouncy

fun fun fun fun FUN!

but the most wonderful thing about Tiggers is I’M the only one.

I’M the only one!

MRRRRRROOOOWW.”

As Ron completed his song with a half-growl, half-meow, Ms. Sprout threw back her head and laughed heartily at the lightbulbs on the ceiling.

“Thanks for that,” she said. “It feels good to laugh.”

***

That was an easy one. There were other encounters in which Ron had to work much harder at lightening the mood, however, because he sensed that the Tigger song would only aggravate their nerves even further. Some friends wrote to him describing how embarrassed they were to talk to him, and some friends were too embarrassed to talk to him at all.

Truth be told, even Ron, who prided himself on his stalwart immune system, was beginning to feel the chills and myalgias associated with Eeyore Syndrome. To make matters worse, he was studying at a new hospital for several weeks, and his old school friends were all fifty miles away – the equivalent of an entire solar system on the scale of medical student time management. He desperately needed a positive inspiration, something that would help him overcomb the Dark Forces encroaching on their world.

That evening, Ron and his new dormmates conglomerated once again in the common room. There was no fireplace, only a pool table and that monstrous TV screen they had gathered around yesterday. They pushed the accessory furniture into the laundry room and arranged the sofas and armchairs in a circle around the coffee table.

In preparation for the meeting, Ron had printed a poster of Harry Potter at the Department of Mysteries: his eyes fierce and vigilant, his head turned to keep watch over his shoulder, his slender wand held poised to defend against darkness from all directions. Ron had first laid eyes on this image more than a decade ago, but it now carried a newfound significance. It symbolized the power of young people to raise their voices above the cacophony of foolishness, and to stand up in peaceful resistance for the sake of their futures. Ron held the poster on his chest as he rose from his seat to address the gathering.

harry-potter-half-jacket

“We are the Order of the Phoenix, and we are not going to fight back,” said Ron. “We are better than that. We are going to heal back.”

The medical students raised anything they could find – their stethoscopes, reflex hammers, feathered quills, and coffee mugs – and raised them to the sky.

Heal back,” they said together.

Their voices echoed softly at first, rising like the rumble of an infant storm; and then, in one fierce moment, they crescendoed into a sonic boom, uniting as a bolt of thunder that resounded through the windows into the icy night.

Heal back! HEAL BACK!”

Flashback to Pediatrics

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“It’s okay, buddy. It’s okay.”

When it became clear that Jimmy was not about to quiet down anytime soon, Hermione lifted him from the hospital crib and settled into the rocking chair behind them. Gingerly, she unraveled the tubes and wires from the siderail of the crib until they draped neatly from Jimmy’s chest, over the armrest, and up to the monitors beside the wall.

“It’s all right, Jimmy. Everything is going to be all right.”

There was nothing left to try, and she was alone in the room with a bawling 9-month-old baby boy. Over the past hour, she had checked his vitals, relistened to his chest and abdomen, changed his diaper, called the nurse, and run down the stairs to ask the residents for help. Still, Jimmy had been crying without pause since seven in the morning, and Hermione had no idea as to why. Help was on the way, however; she only needed to manage the situation for another few minutes.

Now, with the back of his neck resting on the crook of her elbow, Hermione drew Jimmy closer to her chest and began to sing.

R-E-S, C-U-E,
Rescue Aid Society,
Heads held high, touch the sky,
Our hearts we pledge to thee.

With each rock of the chair, Jimmy would close his eyes and relax in her arms, only to let out a wail of agony several seconds later. Hermione continued to sing softly, although she kept an eye on the door and prepared to stop on a moment’s notice.

In a jam, in a scrape,
And you think, no escape,
Do not fear, we’ll be here,
Courageous are we.

Every morning for the past two weeks, Hermione had donned the mask, gloves, and yellow “contact isolation” gown before visiting Jimmy in his room. In between the disposable stethoscopes and painstaking lung exams, she had spent countless moments comforting Jimmy after coughing spells and animating the stuffed animals in his crib.

This morning, however, felt different. It was incredibly difficult to think of a list of realistic complications when thoughts such as this is love kept drifting across her mind.

R-E-S, C-U-E,
Rescue Aid Society…

In the seconds before the team of residents, nurses, and X-ray technicians arrived in the hallway, Hermione held Jimmy tightly and cherished the moment: the steady creak of the rocking chair, Jimmy’s warm cheek nestled against her arm, his fingers curled around her sky-blue glove.

Heads held high, touch the sky,
You mean everything to me.

The Operating Room, Third-Year Edition

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On my final week of surgery rotation, my last scheduled OR case was a tracheostomy wound repair. It was a relatively simple procedure, as it didn’t involve an invasive exploration of the thoracic or abdominal cavities.

During an idle moment around the operating table, I mentioned my first-ever OR experience to the scrub tech.

“It was a heart transplant,” I said. “The room was so calm and quiet, even into the early hours of the morning. It was almost… a spiritual experience.”

The attending surgeon looked up from the table as the resident continued to stitch.

“A heart transplant is a nice operation,” he said. “Easy and clean.”

Easy?” I repeated.

“Yeah,” said the surgeon, shrugging his shoulders. “It’s all about connections. Blood flows through a pump. Now, liver and lung transplants, on the other hand…”

Soon, the operation was complete, the patient was taken to the recovery area, and that was that. I tried to remind myself that the case I had just seen might have been my last-ever surgical case in the OR, depending on what field of medicine I eventually decided to pursue. I found it hard to believe. It couldn’t be true.

That afternoon, however, I was invited to visit an open-heart triple-bypass procedure for the following morning, and I jumped at the opportunity.

***

The surgeon saws into the sternum, through an inch of solid bone, and it all begins. I stand there by the patient’s chest, gazing into its depths.

“Are we at the pericardium yet?” I ask, referring to the yellow layers of tissue that the surgeon slices with his electrosurgical knife.

“No,” he says. “These are fat layers. You’ll know when we get there.”

plateheartarteries

He dissects the last layers of yellow, and the first thing I see is the right atrial appendage, recognizable as the flap with indentations at its edge. It beats on steadily, without faltering, like a bird’s wing in flight. While the surgeon takes a short break to check on another patient, I simply stand there, balancing on the step-stool, mesmerized by the mystery in front of me.

Later in the procedure, I watch as the surgeon and the first assistant pour crushed ice onto the heart. The monitor flatlines, declaring “ASYSTOLE” in capital letters. Two long, winding tubes – one bright red, the other a deep burgundy – drape over the side of the bed and connect to the massive contraption known as the cardiopulmonary bypass (CPB). I try to fathom how all of this man’s blood could be flowing past my knees.

After the grafts have been sewn into place, bypassing the blocked arteries, the surgeon asks for warm blood from the CPB. He places a pacemaker to shock the heart back to life. We watch as the flatline on the monitor morphs into a rhythm we recognize. Inside the chest, the heart is beating again.

I ask, “May I touch the heart?”

The first assistant seems surprised at first, but then she says, “Of course.”

And for the first time, I do what I’ve dreamed of doing ever since I saw that heart transplant nearly two years ago. I reach inside this man’s chest and rest my hand on his heart. It’s warm. My fingers pass over each of the parts in turn – first, the right atrial appendage, then over the ventricles and the border of the left atrium. The attending surgeon encourages me to try the ascending aorta. It feels firm to the touch, just a bit more malleable than cartilage on a chicken drumstick.

“It’s beautiful,” I whisper through my mask, my palm rising and falling with each heartbeat. “It’s so beautiful.”

See also The Operating Room.

A Note About Third Year Thus Far

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I just finished the first half of my third year of medical school.

My physician mentor during my gap year once said something that I’ve remembered throughout these past several months. At the time, she was speaking to another young lady who was about to move crosscountry to start med school, and I happened to be listening to their conversation.

“When you haven’t eaten, when you haven’t slept, when you’ve been standing for hours, remember what you’re doing is so special,” she said. “So special.

Since I began, I’ve experienced so many beautiful moments of grief and joy, of unfathomable loss and heart-rending triumph, that I still like to think it was all a dream. I look back at photos of myself and my family from my gap year – which really wasn’t that long ago – and part of my mind struggles to gauge how much has changed from within. I may have been wearing many of my same favorite outfits, but the person behind that smile has grown to an extraordinary extent in a short amount of time. My classmates and I have delivered life into the world, and held patients’ hands as their souls left the universe. We have been witnesses to the full spectrum of human experience. It’s indescribably beautiful.

As a third-year student, I have personally met and spoken to hundreds of patients (if not past a thousand, at this point), and every single one, as well as the family and friends who cared for them, were good people. Scared, anxious, and tearful at times, yes – but also joyous, hopeful, and genuinely kind. They cared for me as much as I cared for them. Some of my fondest memories consist of sitting in an armchair next to a patient’s bed, long after my assessment was over, and listening to the stories of their grandchildren’s antics.

In the midst of the world’s intensifying tomfoolery over the past year, these ordinary strangers have reinforced my faith in the goodness of humanity. It has been a great honor to work with them.

Snippets from Surgery

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To be taken with a cauldron of salt

As he had expected, Ron was having an excellent time on trauma surgery. He knew absolutely nothing about anything, and yet he was an indispensable member of the patient care team. At the moment, he was standing by the bedside with his hands in his white coat pockets while the rest of the providers swarmed around him (or around the ICU patient, rather).

“Pen!” someone called from behind the bed.

“Notecard!”

“Tape!”

“Suture scissors!”

“Flashlight!”

Ron rummaged inside his white coat pockets for the requested items and tossed them to the appropriate providers. In the meantime, the requests continued to pour in, and Ron hurried to fulfill the demand.

“Stethoscope!”

“One liter IV saline!”

sodium_chloride_1l

Ron smirked at his colleagues’ looks of incredulity as he conjured the bulging bag of fluid from his inside pocket. He felt a gargantuan weight lift from his shoulders, and the seams of his white coat were no longer in imminent danger of ripping open. His heart swelled with the knowledge that he was contributing meaningfully to patient care.

“Lidocaine!”

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Lidocaine.

The smugness faded from Ron’s face. “I don’t typically carry needles and syringes filled with local anesthetic in my pockets,” he said. “Mechanical pencils are bad enough.”

The resident shook his head as he placed another subcuticular stitch in the wound. “That’s your job. Carrying stuff.”

***

Later that morning, Harry scanned the operating room schedule in search of a short case to observe before lunch. He arrived at the assigned OR with ten minutes to spare before the procedure; the patient had already been prepped, draped, and put to sleep, and the OR nurses were discussing weekend plans while they waited for the attending surgeon to finish his previous case. All appeared to be well.

Within thirty seconds of introducing himself to the OR nurses, however, Harry began to doubt his decision. The circulating nurse – a tall, brawny man who had been joking about his Friday-night fist-fight with an oak tree – stopped in his tracks as Harry spoke.

“Is he in a good mood today?” the circulating nurse asked the scrub nurse.

The scrub nurse shrugged.

“Well, regardless, you’ll want to introduce yourself to the attending, once he comes in,” the circulating nurse said to Harry, with a look of sympathy poorly disguised as a quivering grin.

“I’ll do that,” said Harry. “Not a problem.”

At that moment, the double doors erupted with an earsplitting BOOM, closely followed by shockwaves that rattled the scissors and scalpels on their trays. Dr. Snape strode into the operating room with his oversized scrub jacket billowing behind him like the cape of a Dark Lord. He wasted no time in heading straight for the patient’s operating site on the chest, which he examined with an expression of passable approval. The OR staff observed this series of events in utmost silence.

“Er, Dr. Snape?” His voice cracking, the circulating nurse approached Dr. Snape in the midst of the inspection. “Harry’s a medical student here who wants to watch – “

Dr. Snape glanced at Harry, raised an eyebrow, and nodded briskly at the circulating nurse. He then left the OR the same way he had entered – his cape rising like dragon wings, his outstretched arms colliding into the double doors, unsuspecting passersby gasping in the hallway, the doors slamming shut behind him, and a sudden hush in his wake.

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The legendary cape

The OR staff quickly began to prepare the surgeon’s gown and gloves, motivated to be ready for Dr. Snape once he returned from scrubbing at the sink.

“Thanks,” Harry whispered over his shoulder.

“Anytime,” said the circulating nurse.

What It’s Like to Wake Up on Surgery Rotation

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The clamorous cacophony of multiple fire alarms pierced the silence as Ron sprung out of bed, launched over the pile of paper and doorstops next to his shoes, and slid to a halt at his desk. He groped around in the dark for another interminable thirty seconds before his fumbling fingertips encountered the culprits of this particular disturbance.

“Well!” said Ron as he pressed the mute buttons on his phone, tablet, and laptop. “What do you know? It worked! We’re up! Ready for another day of surgery, Harry?”

On the other side of the dorm room, Harry sat up in bed, muttered something unintelligible, and then dropped back to sleep with his ears pressed against the rattling air conditioning unit. Ron stared across the room at the mountainous, rising-and-falling silhouette (he still hadn’t switched on the light) and sighed.

“Maybe you’re right,” said Ron. “A few more minutes can’t hurt.”

With that, he picked up his phone, set the alarm for an additional ten minutes (“3:50 AM? Don’t wake me up!” the phone remarked in protest), and crawled over a stray surgery textbook at the foot of his bed before resting his head on his pillow.

His eyes flew open as the imposter fire alarm set off once again, but this time he stayed in bed and waited for the throbbing lightheadedness to subside from his brain. He eventually gave up, rolled over the side of the bed, slipped his right foot into his left shoe and his left foot into his right shoe, and blundered toward the door.

“I’ll leave the alarm on for you, Harry,” said Ron. The alarm continued to blare into the hiatus of humanity as he started down the brightly-lit hallway with his eyes shut tight, hoping that he wouldn’t collide with another sleepwalking indentured servant on his way to the communal restroom.

In due course, Ron returned to the dorm room to retrieve his phone, devour a chocolate bar for breakfast, and stimulate Harry to the world of wakefulness via an a capella rendition of the Hogwarts welcoming song:

“Hogwarts, Hogwarts, Hoggy Warty Hogwarts,
Teach us something please,
Whether we be old and bald
Or young with scabby knees,
Our heads could do with filling
With some interesting stuff,
For now they’re bare and full of air,
Dead flies and bits of fluff,
So teach us things worth knowing,
Bring back what we’ve forgot,
Just do your best, we’ll do the rest,
And learn until our brains all rot!”

Ron felt no need to change clothes considering that he’d developed a convenient habit of sleeping in his hospital scrubs, and he’d only been wearing his current set for two days and two nights.

Next on his morning routine was the enhancement of his white coat, which came with two large pockets in the front, two large pockets on the inside, and a bonus chest pocket for speedy access to pens and Post-Its. First, he positioned his stethoscope around his neck just-so and clipped his ID badge to his collar (“RONALD WEASLEY, MEDICAL STUDENT”). He then loaded his white coat pockets with an assortment of essential items:

  • eight ballpoint pens in shades of periwinkle, amethyst, grass, salmon, chartreuse, mango, sky blue, and sapphire
  • three strips of Finding Dory and Frozen stickers (for appeasing the children)
  • penlight with pupil gauge
  • suture-removal kit, complete with scissors, forceps, gauze sponge, and plastic tray
  • roll of surgical tape
  • spare suture thread, for practicing knot-tying during longwinded lectures
  • collapsible clipboard
  • seven granola bars in flavors of chocolate, double chocolate, chocolate peanut butter, banana chocolate, cranberry chocolate, coffee chocolate, and triple chocolate
  • twelve pages of surgery notes
  • fourteen pages of patient documents
  • twenty-six pages of surgery case schedules
  • one paperback textbook
  • phone with four-inch screen
  • tablet with seven-inch screen
  • one bag of IV normal saline (0.9%), 1000 mL

The right side of Ron’s white coat sagged down to his knees as he squeezed the last item on his list into one of his coat pockets. He balanced the load by adding a second textbook to a pocket on the opposite side.

Lastly, he reached for his bedside table (in actuality, a spare chair that no longer demonstrated the stability necessary for its intended use) and packed a small bottle of 100 mg caffeine caplets into the back pocket of his scrub trousers. He credited the caplets for preventing him from falling asleep on his feet during surgeries, even after a wholesome 4.5 hours of nightly slumber-time.

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Hmmmm.

With all of the necessary preparations in place, Ron straightened his collar, grinned at the dashing young man in the mirror, and strutted down the hallway to the computer room. There, he would spend the next thirty minutes researching his post-operative patients before entering the hospital to meet them in person. He had about an hour before he was required to meet the resident and attending physician for morning rounds at 5:30 AM.

“It’s going to be an exhilarating day,” Ron exclaimed to a cohort of groggy-eyed medical students as he claimed his computer for the morning. “Just you wait.”

 

 

 

 

 

The Day I Was a Hero

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It was 5 AM. Shrill, incessant beeps echoing throughout the trauma/surgical ICU awoke us from our notetaking-induced stupor. My pager informed me of a “Code Blue” – cardiac arrest – that had just begun in another wing of the hospital. I asked the resident if I could go with him, and we were soon sprinting through the empty hallways, skipping down the staircases two steps at a time, and twisting from one intersection to the next. When we finally turned the last corner, we knew we had found the right place; the room was filled to the brim with a dozen providers, swarming around the man who lay unresponsive on his bed. The patient had developed a non-shockable heart rhythm, which meant that defibrillators would not be of any use.

The resident and I stood just outside the doorway, observing the organization of chaos. “See her chest compressions?” he said softly in my ear, indicating the nurse who was currently on top of the patient. I nodded, and he added, “They’re too slow. Why don’t you go in?”

I dropped my white coat onto the cabinet behind me and sidled through the crowd inside the room. When it was time to switch places, I stepped onto the stool beside the bed, locked my elbows, laced my fingers together, and thrust my entire weight into this man’s chest.

The deafening whirlwind of activity continued around me (“More epinephrine! Another minute!”) but I noticed only my ID badge bouncing in a steady rhythm against my scrub top. My hands and arms dived into the sternum over and over again, in synchrony with my own racing pulse. I had practiced on mannequins many times before, but those experiences were laughable in comparison. At this snapshot in time, I was the patient’s heart.

Once two minutes had passed, I was ordered to step down so that the patient’s pulses could be checked. The room went silent for several seconds as the doctor pressed her fingers against the patient’s femoral artery.

“Pulse!”

“Pulse,” I repeated underneath my breath, my chest still heaving. I blinked several times. My resident was gesturing at me from the doorway. I inched around the crowd unnoticed, threw my white coat over my shoulders, and followed the resident back through the three-dimensional labyrinth of the hospital.

“How was the code?” another resident asked as the two of us returned to the ICU.

“Good,” said the first resident, grinning proudly in my direction. “She saved the patient!”

I knew that he was half-joking – countless other providers had been in the room with the patient, adjusting ventilator settings and calculating doses of fluids and pressors to inject intravenously – but I decided to savor the moment of triumph for what it was.

I never knew the patient’s name, his room number, what medical conditions brought him to the hospital, or even if he survived. I only knew that he had regained his pulse, that it was my first Code Blue, and that for the first time in my memory, I looked in the mirror and congratulated a hero.

See also Dreams of a Sleep-Deprived Medical Student.

The Day I Cut the Optic Nerve

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***Reader discretion is advised. If you are new to this blog, I recommend skipping to a slightly more palatable post, such as The Operating Room. ***

Eye Orbit Anatomy

The eye in the orbit

In the operating room, my attending lifted the drape from the patient’s eye and said, “Ugh!”

It was a dead eye in a living man: the cornea obscured with dark storm-clouds, the sclera yellow and decaying. It had not seen light in many decades.

I stepped forward, looked down at the eye, and shrugged my shoulders. The attending surgeon grinned as he leaned toward the resident, whispering loudly: “It doesn’t bother her.”

For the first enucleation (eye removal) of the day, I tried to stop the bleeding from the central retinal artery, but my index finger was too small – or rather, “petite,” as my attending described it. Blood overflowed from the depths of the eye socket and spilled onto the patient’s ear. My attending graciously took over. (“Not that you aren’t doing a good job,” he said reassuringly.)

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For the second enucleation procedure of the day (on a different patient), I held the scissors in my hand while my attending lifted the otherwise severed eyeball. With a deep breath, I snipped the optic nerve and surrounding vessels before inserting both my index and middle fingers into the orbit. It was a strange, otherworldly sensation: arm held steady in midair, fingers deep in a stranger’s skull, my bones protesting the tight quarters with jagged edges.

“Do you feel the arterial pulsations?” the attending asked me.

I nodded. “You know in the newborn nursery, where you let a baby suck on your finger to help them stop crying? It feels sort of like that.”

I held pressure for three long minutes. When the attending asked me to remove my fingers, I did so with some difficulty. Both the attending and resident were silent for a brief moment as they stared inside the empty orbit. The bleeding had stopped entirely.

“Well, I haven’t seen that in a while!” said the attending, grinning widely behind his surgical mask.

While the operating room staff seemed impressed at how well the bleeding had stopped, I was even more relieved about something else. For the first time in several weeks, since I watched a patient die on a different rotation, I had looked blood in the eye (no pun intended), shrugged my shoulders at its ubiquity, and conquered it. Even when the eye was yellow and lifeless, invoking memories of that other patient’s gaze as I pounded into his chest, my primary emotion during this procedure was neither panic nor grief. It was wonder.

The thrill of the operating room is something to behold.

A Medical Student Reviews HARRY POTTER AND THE CURSED CHILD

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After my first 30-hour shift on trauma surgery, I went straight to Chipotle and purchased my ebook over a well-earned dinner of sofritas and hot sauce. (Alas, the closest bookstore was over 20 minutes away from the hospital.) Sleep-deprived, exhausted, and ecstatic beyond measure, I postponed all of my studying commitments and delved into the story.

I was surprised by what I read, in more ways than one. The following unconventional review is the product of that surprise.

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My first draft of this review, written in the cafeteria on scrap paper from my surgery schedule. (At the top left are my “notes” from earlier that day.) This sheet of paper brought forth some strange looks from my neighbors when I set it on the table during a Friday afternoon lecture. (“What the heck is that?“)

Harry Potter and the Cursed Child - Parts One and Two (Harry Potter, #8)Harry Potter and the Cursed Child – Parts One and Two by J.K. Rowling

A CONVERSATION BETWEEN HARRY AND ALBUS POTTER – A REVIEW OF CURSED CHILD, PLUS A BIT OF FANFICTION

 

Spoilers ahead, although this review might not make any sense if you haven’t read the script already.
See TL;DR at the end for my final comments on Cursed Child.

As the plumes of dark smoke cleared from the dining room, Harry lowered his wand. He gazed upon the mound of molten seaweed that oozed underneath Ginny’s spellbooks and toward his new packet of candles. He had been attempting to shape his creation into the outline of a double-tailed snake, but his culinary talents (or lack thereof) were leading him to a hair-scorching disaster. With luck, Harry hoped, Ginny would never find out; she was currently in London with Lily, preparing to see her off at the Hogwarts Express early tomorrow morning. Harry had gifted Lily something, too – an Extendible Handbag for 7th-year NEWT textbooks – but for this particular occasion, he was aiming for something more special.

Behind him, Harry heard footsteps coming down the stairs. He scrambled to wipe the green sludge off the table with the back of his hand (the sludge settled into a puddle on the seat of the chair, out of sight of the doorway) and stowed the candles in his back pocket.

“Dad? Dad, are you there? I want to show you something.”

Harry spun around, blocking the view of the dinner table, but all thoughts of Confunding Albus quickly dissolved. He couldn’t help smiling as he lay his eyes upon his son – outfitted in forest green dress robes, jet-black hair parted and combed, face and hands washed of all traces of flobberworm mucus and Wiggentree bark.

He had been speechless for too long, he knew, because the corner of Albus’ lip was twitching.

“You don’t need to look at me like that, you know,” said Albus, who was clearly trying not to laugh. “I’ll be okay.”

“I know,” said Harry. He blinked the pins and needles out of his eyes. “May I meet you upstairs?”

Albus scanned the room, gazing a little too long at one of the dining chairs before speaking. “It’s nothing important. I just thought you would like to read this – I found it in one of my drawers while I was packing.”

Albus went back up the stairs, and Harry was left in the vandalized dining room with a battered notebook in his hands. The cover was marked in fading blue ink.


THE CURSED CHILD
BY ALBUS S. POTTER

Four hours later, Harry climbed the stairs to Albus’ room. The walls had been stripped of Wiggenweld Potion flowcharts and Magical Remedies posters, and only the furniture remained. Albus sat up on his trunk as Harry entered.

“Did you read it?” Albus asked.

“Yeah.” Harry took a seat in the armchair by the window. “That was… entertaining, to say the least.”

“I wanted to talk to you about it, because – “ Albus cleared his throat. “I wrote it when I was younger, when I was fourteen. Back then, I desperately wanted to be a somebody in his own right. Like the Muggle scientist Irene Curie wasn’t simply the daughter of Marie Curie, she was Irene Curie the Nobel Prize-winning chemist. I got tired of being known as Harry Potter’s Slytherin Son. I wanted to be known as Albus Potter, His Own Person.”

Harry opened his mouth to speak, but Albus continued.

“You know what’s wrong with it, though? In the story, I go back in time and change the past – your past – with a Time Turner. But I was promoting myself to Hero Mode by planting myself in your story, a story where I didn’t belong under any circumstance. Even my childhood fantasies were defined by your legacy because I wanted nothing more in life than to be you. When I was ten, I daydreamed of being just as awesome as 11-year-old Harry Potter… I made up two villains, named Voldemorta and Voldemortia, and fantasized of how I would duel both of them singlehandedly with only the Flipendo spell. And then I turned twelve, and thirteen, and fourteen, and all I could think of was how you would have been dodging a dragon and diving in the lake and fighting Voldemort… and… I couldn’t take it anymore. If I hadn’t written it, I would have exploded. It was a little boy’s wish fulfillment.”

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I spent countless weeks as a 7-year-old trying to Flipendo Voldemort in this scene from Harry Potter and the Sorcerer’s Stone.

Harry inhaled slowly. “I – I’m sorry, Albus. I’m – “

“Please don’t be sorry,” said Albus. “I didn’t appreciate the joy of everyday Hogwarts buffoonery when I was writing my story, and that’s part of why it fell so flat. I had a magnificent, normal childhood, and I would never change that even if I did find a Time Turner. Scorpius and I scored T’s in Divination class, scrubbed pots in detention with Filch, and planted Dungbombs next to James at the Gryffindor table during breakfast. Whenever I woke up screaming in the middle of the night, it was because I had spotted a spider on the ceiling, and not because I remembered my friends dying in the Battle of Hogwarts. Do you know how priceless that is?”

Harry smiled wryly. “I’m just glad that Voldemorta doesn’t exist.”

Albus shook his head. “You don’t need to bring Voldemort’s bloodline back to reintroduce evil to the world. You only need people like the wizards who followed Umbridge and persecuted Muggle-borns during Voldemort Year – normal people with prejudice lying dormant in their souls until the words of a well-publicized hatemonger reach their ears. And on the sidelines, you also need good people to stand back, do nothing, and insist that nothing can be done.”

Harry squeezed Albus’ hand. “Well, Albus,” he said, “I think you are your own person now.”

“I know,” said Albus, beaming. “I’ll be Healer Albus Potter, the first healer in the family. I’ll be a different kind of hero – not the kind who swoops down on a dragon to save his school from destruction, but the kind who devotes his life to changing others’ lives, one person at a time. I probably won’t ever be in the newspaper, or have my life story passed down in legends, but the magic of healing should be more than enough for me, don’t you think?”

“Yes,” said Harry. “I think you’ll be happy. And that’s all that matters.”

Outside the window, sunset had come and gone. It was almost time for Albus to Apparate to the harbor, where he would be taking a wizarding ship across the Atlantic to the Pukwudgie School of Medicine.

“Before I forget,” said Harry, drawing a long leather box out of his extendible pocket, “I was trying to make you a cake in the shape of a stethoscope, but even the Elder Wand wasn’t a match for my dismal baking skills – “

“So that’s why the kitchen smelled like Dungbombs,” said Albus.

“– with the help of the Elder Wand, though, my craftsmanship isn’t so bad,” continued Harry. “I made you this.”

Harry watched as Albus lifted the lid and found a wand made of willow bark, carved with the form of a serpent entwined along its shaft. Albus held the wand gingerly in his palm, and the bedroom glowed with a soft periwinkle light.

“A healing wand,” murmured Albus.

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The Rod of Asclepius, symbol of medicine

 

“The Sorting Hat made a beautiful choice when he placed you in Slytherin,” said Harry. “Do you like it?”

Without warning, Albus threw himself into Harry’s arms. Harry fell back in his seat, and suddenly he was holding newborn Albus, gazing into the green eyes, his own green eyes, the microscopic fingers curled around his thumb, the chest rising and falling with the occasional hiccup, milk-stained lips twitching with blissful dreams, tufts of jet-black hair already gleaming with grease. He had whispered into his lap, Albus, you’re perfect, over and over again, for hours on end.

For now, Harry held nineteen-year-old Albus in his arms for a little while longer. He wished, more than ever, that he could turn back the years to Albus’ first time at Platform 9 ¾ and relive the journey all over again.

TL;DR

The Good: The raw, honest, touching relationship between Harry and Albus made The Cursed Child worth reading.

The Bad: The Time Turner plot mutilated the stories and characters we’ve known and loved for more than a decade.

The Ugly: The concept of Bellatrix having a child with Voldemort during Harry’s 7th year is an insult to the intelligence of readers everywhere.

My overall rating: 2 of 5 stars, 2 for the return to our beloved Hogwarts and 3 for the father-son relationship, -1 for the plot and -2 for the ludicrous resolution.

Obstetrics, Part 2: A Discomfiting Distraction

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To be taken with a few pinches of caution! (You have been warned.)

That evening, when Ron arrived at the Labor and Delivery floor for another 14-hour shift, Hermione invited him to join her for a questionable opportunity.

“Dr. Pomfrey is going to circumcise one of the newborn boys in a few minutes,” said Hermione. “Would you like to come?”

“Of course not,” said Ron.

He watched as Hermione turned around and headed to the newborn nursery, skipping with every other step as soon as she was past the nurses’ station.

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The hospital in the evening is a strange and mysterious place…

Ron remained at his desk for another few minutes and waited for a patient to deliver. No one delivered. He soon found himself standing in front of the door to the newborn nursery, gazing through the window at the discomfiting sight.

Dr. Pomfrey stood at the foot of the operating table with a metal contraption and a scalpel in hand. Hermione leaned over the head of the table, attempting to simultaneously hold down the baby’s arms and squirt sugar water into the baby’s mouth. When the baby’s face contorted into a deafening wail, Hermione scrambled to find another squirt vial; but alas, there was none.

“Oh no, buddy! It’s okay! It’s okay!” Hermione rubbed the baby’s sternum and squeezed his hand, but the baby only screeched louder.  To Dr. Pomfrey, she said, “Isn’t there any more of the sugar water?”

“They only get two of those per procedure,” said Dr. Pomfrey without looking up from his ominous contraption. “He’s been anesthetized, remember? The sugar’s just a distraction.”

Hermione’s eyes bulged as the baby’s voice reached a note hitherto undiscovered by humanity. “Is there a pacifier I could give him?”

“You should have thought of that before.” Dr. Pomfrey grimaced as he twisted a metal knob.

By the time Ron stepped tentatively inside the nursery, however, all was quiet. The baby had locked his lips around Hermione’s gloved little finger. Hermione looked up from the operating table and grinned at Ron.

“The suction is unreal,” she said. “Do you want to try?”

“No thanks,” said Ron, trying not to look at the surgical field too closely. “I’ll just… stick around for the time being.”

A few minutes later, Dr. Pomfrey cleaned the wound, dressed the baby in a new diaper, and left the nursery. Hermione swaddled the baby in a blanket and began rocking him in her arms.

“Do you want to hold him?” Hermione asked, as Ron stepped closer.

“No thanks,” said Ron. He looked down at the bald, cone-headed baby, who was now trying to eat Hermione’s scrub top. In that moment, Hermione’s eyes melted like chocolate ice cream in the microwave.

“Oh, look,” said Hermione, oblivious to the escalating pallor of Ron’s face. “Our little buddy is hungry. Isn’t he sweet?”

Ron stared at her with his mouth agape. Recalling the relentless game of Interrogation from the previous evening, he considered the possibility that an impostor had disguised herself as Hermione.

“You really like babies, don’t you?” said Ron.

Hermione scowled at him. Ron was starting to feel all sorts of discomfort, so he excused himself from the room. As far as he could tell, Hermione was a lost cause the moment she had first laid eyes on the newborn nursery.

Obstetrics, Part 1: Hallucinations and Interrogation

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One beautiful evening, Hermione was working the night shift on the Labor and Delivery floor – or “night float,” as they all called it. Then again, she hadn’t looked through a window since a couple hours before sunset, but she chose to imagine that the sky was gorgeous tonight.

She rose from her stool and went to check the monitor at the nurses’ station. All four patients on the floor today were still in the latent phase of the 1st stage of labor. The nurses clustered around the door to the women’s lockers, chatting about upcoming graduation ceremonies and days off of work. The resident physicians dictated patient notes at 400 words per minute and picked away at their dinners in between cases. The attending physicians were nowhere to be seen. Hermione returned to her desk.

With bleary eyes, she proceeded to open her copy of Changes of Labor And How To Find Them and underlined entire paragraphs of text with her blue pen.

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A few minutes later, her midnight bedtime alarm went off. In a different life two days ago, she would have taken the cue to brush her teeth and pack away her textbooks for another day. Now, she simply turned off the alarm and tried to ignore the fellow student whose slumber she had disturbed.

“Hermione…” The voice moaned softly.

Hermione counted 15 seconds before answering so as to make him feel as uncomfortable as possible. “Yes?”

Ron sat up in his chair and smoothed over the crumpled pages of his textbook, which he had been using as his teddy bear.

“The struggle is real,” he said.

Hermione never lifted her eyes from her book; in fact, she suddenly felt more alert than ever. She also sensed that Ron was watching her, which gave her another incentive to finish reading twelve pages in five minutes.

“Aren’t you tired?” Ron asked.

“Eh,” said Hermione.

After another long hiatus in their conversation, Ron said, “I’m going downstairs to buy some Distilled Double Coffee from the vending machine. Do you want anything?”

“No thanks,” said Hermione.

When Ron had still made no move two minutes after his last spoken word, Hermione bookmarked her page and turned to face him.

“Do you want to play a game of Interrogation?” she asked.

“Of course not.” Ron furrowed his eyebrows. “What’s Interrogation?”

“It’s the med school variation on the Socratic method,” said Hermione. “It’s known more commonly by a slang term that has terrible connotations – ”

Ron’s eyes grew wide. “You mean pi – ”

“Yeah, that,” Hermione said quickly, “but that word stinks of slavery and human trafficking. ‘Interrogation,’ however, is not torture, so it’s a much more suitable alternative, don’t you think?”

“All right, sure,” said Ron, “but I should really go and grab a – ”

“Great, let’s play,” said Hermione. “I’ll start as the interrogator. What are the components of the fetal Biophysical Profile, also known as BPP?”

“I don’t know,” said Ron with a loud sigh.

“No problem,” said Hermione. “Just memorize these five things: non-stress test, fetal breathing movements, fetal movement, fetal tone, and amniotic fluid index. Next, what are the four main pharmacologic agents used to treat postpartum hemorrhage, and what are their contraindications?”

When Hermione had run out of questions, she asked Ron if he wanted a turn as the interrogator. Ron blinked slowly.

Hermione glanced at the clock on the desktop computer. It was 3:00 AM.

“You know, if you’re bored,” Hermione suggested, “the babies in the newborn nursery give out free cuddles.”

Ron frowned at her. “Why would you want to hold someone else’s baby? That’s so weird. And what if I drop the baby?”

“You’re not going to drop the baby, Ron…”

After they had miraculously stayed (mostly) awake for another four hours, it was time for sign-out. Hermione and Ron stood in the back corner of the meeting room while the attendings and residents gathered around the table to discuss how patients had progressed overnight. (Hermione had once tried to take a seat at the table, but the attending physician graciously explained that these seats were reserved for physicians.)

Suddenly, Hermione felt someone tapping her on her right shoulder. Her eyes flew open, but the only thing next to her on that side was the brick wall.

She closed her eyes to blink, and she was following her advisor through the hallways of the local clinic to meet a Martian patient, but then she caught herself from faceplanting on the meeting room floor. She looked around quickly to make sure that no one else had noticed the sudden jerk of her neck.

Hermione now gave up on keeping her eyes open. She decided instead to close her eyes and pretend that she was concentrating on translating OBGYN acronyms in her head. PEC, TOC, PROM, PPROM, PPPROM… PB&J, PJs.

Once the meeting was over, Ron met Hermione in the main hallway.

“You were dying in there,” Ron said, smirking. “Your eyes were like glass marbles.”

“I wasn’t dying, I was hallucinating,” said Hermione. “I’ll see you tomorrow, then?”

“Today, you mean,” said Ron. “Five PM.”

“Yeah, that,” said Hermione. “Good night.”

“Good morning,” said Ron. “Sleep well.”

They walked out of the hospital into the sunny morning, where hordes of traffic were just starting to head to campus for a long day of work.

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The Day Before Third Year

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The day before clinical rotations began, Hermione rummaged in her closet for her old Comet Two-Sixty broomstick. She had to brush off the dustbunnies before she could read the logo again, and the speed settings were infantile compared to Harry’s legendary Firebolt, but she didn’t need extravagance. She needed freedom.

Outside, the mist hung over the campus of Hogwarts College of Medicine like the obscurity of a dream. Droplets drifted from the sky at such a gentle pace that Hermione’s sweater never felt damp. She closed her eyes as the cool mist sprinkled over her nose, and the breeze flowed through her sleeves until her arms weighed nothing at all. For just a moment, she believed that she was born with wings.

Upon leaving the main campus, Hermione soared up and down the rolling hills, brushing past the last of the cherry blossoms beside the trail. She glided to an arched wooden bridge overlooking a pond, where mallard ducks slept with their beaks burrowed in their feathers while ducklings frolicked nearby.

I could live like this forever, she thought, as she leaned against the railing of the bridge with one arm around her broomstick. From her vantage point, the towering trees blocked her view of the nearby houses, and she imagined that she was venturing into a rainforest.

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Hershey Gardens, Hershey, PA

When she thought about the upcoming week of her life – no, she didn’t want to think about it. It wasn’t happening. It wasn’t going to happen. She identified as a second-year medical student, the kind of student who hid in the Hibernation Cave for twelve hours a day, surrounded by sticks of sugar-free gum and empty coffee cups, and boasted about how much her studies were tiring her. She shivered at the idea of becoming an apprentice doctor who spent fourteen hours a day on her feet and five hours a day studying, with the remaining hours divided between napping and personal hygiene.

Aside from the shift in identity, there were other, perhaps more grave, factors to consider.

“I had an interesting patient with this condition,” Hermione had heard the upperclassmen say, many times over. “We went through these interventions. He died the next day, though. And there was another patient with that condition, but he lasted a couple of days. And then there was another patient – “

For all of her experience with dramatized notions of death, Hermione felt an electric shock pulsing up her spine when she realized how often her senior classmates had encountered death, and how ordinary of an occurrence it had become to them.

I’m not ready for this, she wanted to say out loud. Not ready not ready not ready –

But she was.

She had waited her entire life for this moment. At long last, she was becoming a healer. For the first several weeks and months, she would begin as a cringeworthy, bumbling fool of a healer; she harbored no fantasies in that regard. But eventually, as Harry had reassured her yesterday, they would all wake up one morning and discover themselves as doctors. MDs. Not point-five MDs, but young, talented, caring, vibrant, brilliant, complete MDs.

We promise to listen with open minds and open hearts

To teach and to learn

We promise to advocate for all persons

By protecting life and upholding human dignity

They had recited this oath out loud at their White Coat Ceremony, but at the time Hermione had been more concerned about keeping pace with her classmates than with pondering the implications of her words. Now, she held the sounds of the moment in a corner of her mind, froze them in time, and relaxed as they soaked into her being.

Yes, she thought as she stood on the bridge by the rainforest, immersed in the threshold between spring and summer. This is who I strive to be.

 

 

 

Gastrointestinal Adventures, Part 2: Flight of the Food Fairy

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To be taken with a cauldron of salt

Several times a week, Harry looked forward to meeting The Magic Food Fairy, a being even more wondrous than her legendary cousin, The Book Fairy.

After classes concluded for the morning, Harry would fly up the stairwell and camp out in one of the lecture halls until sustenance arrived, followed closely by gaggles of medical students who had squandered time in the bathroom after class. As soon as the trays were set, Harry would pile the delectable delights onto his paper plate and scurry off to claim a seat in the back row. His favorite lunch was Chinese tofu and fried rice, although he appreciated the usual pizza and sandwiches, as well; even the blandest of foods tasted scrumptious when they were free.

Today’s lunch lecture, however, was going to be different. They would be serving Indian food: garbanzo bean curry and lentil soup, topped off with rice that was prepared with magical Indian secret ingredients.

Oh, yum.

(Yes, there was a catch. The Food Fairy served free lunch to famished students only if they agreed to stay for an extra hour of lecture about special topics such as neurosurgery and foreign medical systems. Harry didn’t mind this stipulation so much, however. The Food Fairy had earned her reputation as a just and generous entity.)

It was now 10:00 AM; he only had to persevere through another two hours of class before it was time to eat. His stomach roared so loudly that Hermione glared at him from her seat, packed her bag, and moved to the front row.

Harry scanned the seats around him for signs of Ron’s whereabouts, without success; he guessed that Ron was somewhere in the back row practicing his multitasking skills.

The classroom went silent as the first professor stepped up to the podium.

***

In their past courses, the cardiology professors had spoken highly about the heart.

“No poet can describe the magnitude of its majesty; it is the manifestation of the soul, the servant that never tires, the perpetuator of life…”

The renal professors had different opinions.

“The only purpose of the heart,” they had said, “is to pump blood to the kidneys.”

No professor to date, however, had ever matched the enthusiasm of their professor that morning.

“The LIVER is the MOST IMPORTANT organ in the ENTIRE BODY!” The hepatology professor paused to wipe the sweat from his microphone. “You can live without your KIDNEYS if you go on dialysis! You can live without your STOMACH and INTESTINES – “

No, you can’t, Harry muttered underneath his breath.

“- You simply have sustenance injected into your veins with total parenteral nutrition! You can live without your HEART if you get a left-ventricular assist device! You can even live without your BRAIN – those people in Washington do it every day! But your LIVER! Take out your LIVER, and you’ll be gone in SIX HOURS!”

There was some discordant muttering among the medical students at this assertion.

***

The liver professor never had the chance to complete his speech. The second professor arrived promptly at 11:00 AM, strolled down the aisle, and stationed himself in a front-row seat. Then, with a roar that could have shaken all the snow off Mount Everest –

“TIME’S UP, YOU’RE DONE!”

Without another word, the liver professor shut down his presentation and escaped from the classroom. The second professor replaced him at the podium.

“THIS LECTURE WILL DISCUSS AND ELUCIDATE THE ESSENTIALS OF DIARRHEA!!”

Oh no, Harry thought.

For the next forty-five minutes, the unfortunate students in the front row clamped their hands over their ears as the professor’s thundering voice hauled them through the intricacies of watery diarrhea, explosive watery diarrhea, fatty diarrhea, black tarry diarrhea, and bloody diarrhea. If Harry had not known English, he would have guessed that the professor was preaching about the horrors of Sin, The Angel of Death, Judgment Day, and Hellfire. But no – he was preaching about a dreadful enemy that prompted students of all backgrounds to tremble in their seats – DIARRHEA.

At the climax of the sermon, Harry felt an urge to hide underneath his desk.

YOU SHALL NOT GIVE ANTIDIARRHEAL AGENTS TO PATIENTS WITH INFLAMMATORY DIARRHEA!!

you shall not antidiarrheal

Once the lecture was finished and the microphone was disconnected, Harry went to meet Hermione in the front row. Hermione’s knees buckled as she tried to rise from her seat; her hands remained clasped against her ears.

They met each other’s eyes.

Harry was the first to speak.

“Well,” he said, “There goes my lunch.”

Together, Harry and Hermione elbowed their way through the crowd, burst into the hallway, and redirected to the nearest window when they realized that the bathrooms were thirty feet away.

That was how Ron found them when he sauntered around the corner, whistling with a plate full of garbanzo bean curry in his hands.

“Hey guys, aren’t you so glad we got out of lecture early today? You know, there’s free food upstairs – “

Gastrointestinal Adventures and First-World Problems

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To be taken with a cauldron of salt, and a pinch of caution – as with anything related to medical school

One afternoon, Hermione decided to study for her GI exam in the same corner of the library as Ronald Weasley.

Fifteen minutes later, she regretted her decision. For one thing, Ron was fascinated by the widespread practical application of everything they were studying. Secondly, he liked to chant provocative phrases from class to help commit them to memory.

“Yersinia-Campylobacter-Histolytica-E. coli-Salmonella-Shigella make bloody diarrhea, bloody diarrhea, bloody diarrhea, bloody DIARRHEA – “

The last part was catchy, Hermione had to admit. She soon found herself chanting “diarrhea, DIARRHEA” underneath her breath as she read about the medicinal uses of bismuth subsalicylate, also known as Pepto Bismol.

When she rose from her seat to take a well-deserved bathroom break, Ron began to recite aloud the physiologic principles of large intestine motility – as if she, Hermione Granger, needed a reminder about that. If she hadn’t already claimed her favorite armchair, she would have permanently relocated her study spot to the safety of the school Dungeon.

But now, at 11 PM, thank heavens, Ron was done chanting. He lifted his feet onto the table in front of him and started watching videos on the internet. Hermione burrowed deeper into her chair and continued to read in peace.

But then, twenty minutes later –

“That’s cheating! CHEATING!”

Hermione looked up from her textbook page on the gastrocolic reflex. “What now, Ronald?”

“They can’t just skip ahead five months without saying anything about it! Do you know how many things could happen in five months? You could fly halfway to Mars! Kayak across the Pacific Ocean! Eat fifty pounds of ice cream! Develop steatohepatitis! But no, they decide to skip – “

Hermione shut her textbook and sighed. “That sounds like a dynamic TV show.”

Ron grumbled incoherently.

“You know,” Hermione said, “as stories go on, writers tend to skip longer and longer periods of time between plot-related events. It’s different at the beginning of the story, because the writers are trying to develop the setting and characters, and nobody would trust the characters if they went missing-in-action for several months. But later, you need to allow everyday happenings to take care of themselves in the background. The truth of the matter is, real life isn’t edited in a film studio. Once you get past the thrill of discovering a new world, it would be horrendously boring for someone to watch the characters hibernate in a library. That’s why many decent writers refuse to churn out blog posts about sleep deprivation every other day. We have to wait until we can offer something new to our readers – something worth their time.”

Ron had fallen asleep in his bean-bag chair. Hermione scowled at him from across the room.

“And besides, don’t you have an exam to study for, Ron? Wouldn’t it be nice to avoid failing?”

Ron opened his eyes, blinked, and yawned. “Stressing about failing is a first-world problem, especially if it’s a class you could repeat in a couple of months. Just take a look at today’s front page of The Daily Shenanigans; read any of that with an open mind and it puts all of our silly little troubles into perspective. But I digress. I always digress. Back to bogus business.”

He reached back for his copy of Fundamentals of Pathology.

Soon afterward, Ron and Hermione were ushered out of the library by cold stares, fiery glares, and gasps of disbelief. Certain phrases that were deemed appropriate in a med-school GI class, unfortunately, were considered highly unsuitable for a public, family-friendly environment.

The Hogwarts Trio’s Tips for New Medical Students

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To be taken with a cauldron of salt

On his way to school, Harry found sheets of white velvet sprawled over the sidewalk. For a fleeting moment, Harry thought he was standing on a million specks of bird droppings – but then he noticed the white flowers in the tree outside his window.

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Sometime during his hibernation in the library, spring had arrived. Harry felt as if he had never seen so much green before – a luscious, deep green, carried within the tiniest buds dangling from the branches of winter. During his afternoon meetings, he would imagine himself diving into that green-ness, gulping down the sour whiff of mustard flowers, savoring the taste of rain.

Mount Gretna, PA

Mount Gretna, PA

Harry wished the pink flowers would remain on the trees forever, like brilliant bursts of sunrise scattered throughout the midday skyline. But everything was changing, and would continue to change.

photo 1photo (3)

The previous second-year students had advanced to their third year of medical school. One day, they were poring over textbooks in the Hibernation Room of the library, preparing for their high-stakes board examinations. The next, they were dressed in mint-green scrubs, with white coats over their shoulders and hospital pagers clipped to their pockets.

The new first-years were preparing to arrive. The class forum bubbled with questions about textbooks, laptops, student life, and housing – and Harry found, to his surprise, that he knew the answers to these questions. It was a bizarre feeling.

In just a few weeks, Harry would become a second-year medical student.  When his non-medical friends asked him questions, he would no longer be able to respond with “I don’t know anything – I’m just a first-year medical student!” He was no longer an embryo in the vast world of medicine.

“Can you believe an entire year’s gone by?” Harry said to Ron and Hermione in the Great White Tent later that day.

“Yes,” said Ron.

“No,” said Hermione. “And that’s why I think we should draft a letter to the future first-year students of Hogwarts College of Medicine. No one remembers their first year of medical school more vividly than we do now.”

Harry fished out a fountain pen and a notebook from his book bag and set them on the table. Ron went first.

  1. Get involved with as many research projects, service activities, and student groups as you can during your pre-clinical years. Everyone in medical school has good grades, and for residency applications you’ll have to set yourself apart another way. – Ron

“I spent the first six months of medical school eating from noon until 6 pm, and studying and eating from 6 pm to 1 am,” Ron explained. “So that’s why I decided to get more active in the school community after New Year’s.”

“We all know you’re the president of twenty different student interest groups, Ron,” Hermione said.

“Who, me?” Ron raised an eyebrow. “Nah, just one interdisciplinary student group. That’s all.”

“Which reminds me – “ Hermione said.

  1. Explore as many different specialties as you can during your pre-clinical years. Go into each new field with an open mind. This is your chance to explore – to shadow heart transplants and C-sections, and delve into new fields you never knew existed, before you are responsible for a patient’s life. You’ll never have more time than you have now. Make it count; you’ll cherish the memories for years to come. – Hermione

Harry wrote:

  1. Find a way to keep yourself human throughout medical school. Something unique about you – whether it’s cooking, art, running, or creative writing. Schedule fifteen minutes of protected time every day for that hobby. – Harry

“I didn’t think I had much time for anything,” Harry said. “I was driven by my fear of flunking out of medical school. So I put off a lot of important things. Like taking a walk. Taking a nap. Taking out the trash. Picking my dirty socks off the floor of my bedroom. But in reality, I did have time for those, even on some of the stormiest days of our cardiology block.”

“I can translate all of that to Medical Studentese,” Ron said.

  1. Don’t take studying TOO seriously. Really. Not as a first-year medical student. You have the entire rest of your life to stress out to your heart’s content. Right now, just try not to fail any classes. When you’re short on time, don’t read anything you don’t intend to memorize. Take a nap instead. Read some cheesy YA fantasy novels. Eat chocolate. Chill. – Ron

“You know how I feel, mate?” Ron said. “Sometimes I can’t believe what just happened to us. It’s as if someone last year chucked a pre-med into the coin slot of a vending machine, and after a lot of grinding and whirring and sirens (because the old decrepit thing set off the smoke detectors) – a 2nd-year med student popped out of the space where the potato chips should have been. Just like that – zib, zab, zoob. Done. And now I can call myself a 0.25 MD.” He conjured a business card from his white coat pocket and presented it to Harry and Hermione.

Ronald Bilius Weasley, B.S., 0.25 MD.

President, Cosmetoneuroorthopedic Trauma Surgery Student Commitment Society

Hogwarts College of Medicine, Class of 2018

“Impressive.” Hermione checked her watch. “Just a little premature, Ronald. We’re not quite finished yet. We’re still 0.2375 MDs.”

In the meantime, Ron had already opened a map on his tablet and begun to plan his route to his next weekend getaway spot. Normally, Harry would have declined the offer to join such an outing, because he had loads of things to study for – all the pharmacology, pathology, physiology, and pathophysiology of urine – but that didn’t matter right now. He needed to see the last of the spring flowers.

“You know you’re in medical school,” muttered Harry, “when you see a town called Pottsville on the map and immediately think of tuberculosis.”

“Or cheesecake,” Ron added. “Yum.”

A year ago, if Harry had spied on his older self, he would have understood nothing. And a year from now… Harry could not imagine. It all seemed eons away, but Harry knew how wrong that was.

Their journey was just beginning. What would come, would come, and he would have to meet it when it did. Harry intended to savor every moment.

But for now, Harry stepped outside into the humid air. He felt his heart lift at the thought that there was still one last day of spring left to enjoy with Ron and Hermione.

Farewell to First Winter

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March 9th, 2015

March 9th, 2015

First day of above-freezing temperatures

Why am I feeling this inexplicable regret as I watch the yellow grass emerge from beneath the blanket of snow?

Water dripping from the balcony above serves as a reminder of the wonderland that surrounded us, only two days ago, when the world was covered in icing from a birthday cake.

Streams of melting snow frame the narrow roads around the College of Medicine today, washing away the memory of winter…

This may be the last time I see you, dear First Winter. We have been through many adventures together. Do you remember:

  • The time I slipped on a mound of ice on my way to school, and spent the entire lecture trying to preserve my keyboard’s hygiene
  • or the time I finished reading a novel in the car while I waited for the sleet to melt on my windshield
  • or the time I slid across a sheet of black ice in the courtyard by the library, only to exclaim, “I sprained my medial collateral ligament!”
  • or the time I decided to walk to school when it was zero degrees Fahrenheit outside, so I could fully experience this milestone in my life.
Sunrise on January 11th, 2015

Sunrise on January 11th, 2015

Such wonderful adventures; I will never forget the thrill of discovery.

As I was growing up, “snow” was synonymous with “holiday.” And thus I spent the last two months of my life on an extended vacation – a “Thanksgiving Take Three,” as it were.

I’ll miss the satisfying crunch underneath my boots, the simulated experience of marching toward the South Pole on a foolhardy expedition.

I’ll miss my routine of emailing my parents a screenshot of the forecast every morning.

I’ll even miss hearing others complain about the weather – because I know, like any true expeditioner, that subzero temperatures are nothing to complain about. It’s just air, after all.

And now, as I walk outside with only a featherweight jacket over my shoulders, I notice something I have not seen in months: bird droppings, splattered over the trunk of my car. I scoop a handful of melting snow from underneath the tree and scrub away the last of the blemish. After all, my bottle of Windex is still frozen solid.

Aftermath: March 20th, 2015

First day of spring.

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The Operating Room

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I was about to sit down for a warm pre-dinner snack of daal, rice, and tilapia when my phone buzzed insistently from the tabletop. I stood there for a moment, staring at the screen, until I processed the words, “meet me in 30 min.” I wolfed down my dinner, stuffed my ID badge and white coat into my laptop bag, and dashed out the door into the freezing evening weather.

When I arrived at the hospital, I was sweating profusely into my jacket. I met my research advisor in her office, and she led me into a new world – one of windowless hallways, where there were no lost visitors or rambunctious first-year medical students to penetrate the silence. There were only faceless doctors and nurses, solemn and solitary as they headed toward their mission.

In the operating room, I watched as the anesthesiologists placed their monitors on the patient. Just before the patient went to sleep, he mumbled, “What time is it?”

I looked back at the clock. It was 9:33 PM.

When the patient could no longer open his eyes at the doctor’s request, the surgery began.

I continued to watch as the surgeons marked the operating area with black ink. They began with a single incision that pierced his skin and the membranes that held his muscles together. Then they split apart his sternum, and delved into his chest…

A heart transplant. Not just any open-heart surgery, but a heart transplant. A wave of wonder swelled and burst inside of me. I instinctively felt for my own heartbeat, searching for its warmth underneath my scrub top and jacket. The organ that pumps life throughout our body – the one organ that seems to cradle our very soul – would be taken out from the depths of this man’s chest and replaced with a new one. And I was worried about passing my hematology exam.

Through the night, I peered over the curtain as the surgeons freed fibrotic tissue from around the diseased heart, like sculptors chiseling away, ever so slowly, at a block of marble. I held my breath as the entire heart came into view. I had never seen anything more beautiful than that heart, beating away in plain sight from the depths of this man who lay before me, a man who had been speaking to us just a couple of hours ago.

How different surgery was from dissection in the cadaver lab. The silence, save for the steady whirring of the machines and the occasional announcement about the arrival time of the donor organ, was in stark contrast to the incessant chatter and narrowly-dodged bone saws characteristic of first-year anatomy. This operating room felt like a temple of prayer in comparison.

At one point, I looked back at the heart to find that it had stopped beating. The surgeons were diverting the blood flow to a cardiopulmonary bypass machine – a massive glass contraption that took in deep purple, deoxygenated blood from the patient’s chest and returned tomato-red, oxygenated blood through a tube into the chest cavity.

Nearly three hours after the surgery began, the new heart arrived by helicopter. The surgeons continued to carve away inside the patient’s chest- until one surgeon reached both of his hands into the cavity, and in one fluid movement, scooped out the entire heart. There was now a gaping hole in the patient’s chest – empty except for a deep pool of bright red blood. I went around to the other side of the operating table to gaze at the severed heart.

With slender blue threads, the surgeons soon began to sew the valves of the donor heart into the patient’s chest cavity. That was when I decided to leave. It was 1:00 AM.

One day later, I still I wish I had stayed for the entire surgery.

See also The Operating Room, Third-Year Edition

heart netters

Since the night of the heart transplant, I’ve had the opportunity to hold numerous human hearts in my hands and casually describe all of their external and internal structures.

The Medical Student Commiseration Conference

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To be taken with a cauldron of salt

After Health Systems class one day, Harry staggered into a small classroom occupied by disgruntled medical students. He could not bear to think of the heaps of dermatology notes and photographs awaiting him in his backpack. Listening to other human voices could be reassuring, even when those humans were more stressed than he was.

In this particular room, Ron and Hermione were sharing a hushed conversation over lunch. Hermione glanced out the window every fifteen seconds before returning to twiddling her thumbs.

“I know I’ve failed everything,” whispered Hermione as Harry took his seat. “The anatomy lab practical was no good at all. I definitely mixed up flexor hallucis longus and flexor pollicis longus. And I thought that Radiology went all right at the time, but looking back – “

At that moment, the door burst open. Two fellow medical students entered the room: Igor, one of Ron’s new friends, and Daphne, one of Hermione’s new study partners. Like most of the first-year class, both Igor and Daphne were East Coast witches and wizards, people Harry had never met before in his life. Harry had thought them strange at first, with their East Coast variations of Rock-Paper-Scissors and deep-rooted dislike of snow. But now, six months later, they were all united in their exam-related anxiety.

This is fine

The key to surviving medical school.

“I don’t understand why we have three exams in two days,” Daphne said, dropping into her seat next to Hermione. “I mean, how could you possibly study for dermatology and orthopedics and rheumatology without a single devoted Study Day before the exam?”

“I don’t know,” Igor said. “I don’t think anyone in their right mind could memorize this much in such a short period of time. Or expect us to, for that matter.”

“How are all of you studying for Health Systems?” Harry asked. Thinking of Health Systems’ impending exam gave Harry a sore throat. He had been spending so much time with Scientific Principles of Medicine, The Voldemort Lab, and Ortho/Derm/Rheum that he had neglected to complete any Systems homework for the past two-and-a-half months.

Ron, Igor, Hermione, and Daphne shrugged in unison.

“I’ll worry about Systems at 11 pm the night before the exam,” Ron said.

Four weeks after the end of their first module in The Voldemort Lab, Ron Weasley was a changed man. His repertoire of ill-fated puns had diminished to a mere trickle, and Harry could see him studying in a carrel at the library from time to time.

“But what about anatomy? The practical exam?” Hermione moaned. “It’s been weeks and we still haven’t gotten our grades back.”

“Well, if it makes you feel better,” Ron said, beaming, “the scores for The Voldemort Lab were historically low this year.”

How is that good news, Ronald?” Hermione snapped.

“If we fail, we need to all fail together,” Ron said.

“I’m even a little worried about Humanities,” Hermione said. “I mean, what if I wasn’t writing enough?”

“Hermione, you would have to be sleeping in class to fail Humanities.” Daphne slapped Hermione on the back. “I would have sworn that some people in my class wrote their responses with their phones propped up against the handlebars of their bikes on the way to school.”

Ron and Igor exchanged uneasy looks.

As their binders and dermatology textbooks lay abandoned on the table, The Commiseration Conference continued into the afternoon. There was no dearth of grievances to complain about, after all:

  • Harry had only been sleeping five hours a night for the past three weeks.
  • Ron and Igor had learned more about Kawasaki disease from their favorite TV show than from the rheumatology lecture on vasculitis. (Upon further questioning, they admitted to sleeping in the lecture hall that morning.)
  • Hermione had no idea how many short-answer questions would be on the orthopedics portion of their upcoming exam.
  • Daphne was worried about whether or not they were expected to memorize all four of Kanavel’s signs for flexor tenosynovitis.

At long last, Harry cleared his throat.

“I don’t think we should be worrying about any of this,” Harry said quietly. “If there’s one thing we learned from the past six months, it’s that we stress out for no reason. Things are never as bad as they seem.”

Harry was surprised when the entire room fell silent. Swallowing the last bit of moisture from inside his cheek, he opened his mouth again.

“We pass through the hospital every day on our way to class. We walk past kids with no hair, and teenagers unconscious on gurneys. And what about the people we know? Two of our own professors have lived through bone marrow transplants. One of them was in his early twenties – our age – when he found out he had cancer.

“What are we even complaining about? This is silly. Even if we fail a class or two they won’t kick us out of medical school. We might need to repeat a year, maybe, if we do poorly enough. But the people we know so well spent years of their life in and out of treatments, with no guarantee they would ever return to a normal life.

“Have you ever walked past the Interfaith Chapel, with its Prayer Requests form displayed in the antechamber? I stopped to read through the requests one day, in the midst of our rheumatology week. I wish I could wave my stethoscope-wand and solve all of their problems, but I’m at Hogwarts College of Medicine, not Hogwarts School of Prayer and Miracles. There I was, agonizing over all the different subtypes of psoriatic arthritis that I hadn’t memorized, and a family was praying for their loved one to wake up from a stroke. I felt ridiculous. I should have known better.

“Have any of you read our professor’s cancer memoir? After his bone marrow transplant, he wanted to worry about something trivial. Like bad grades. Not something like overwhelming his infantile immune system with the least bit of a fresh garden breeze. Don’t you see? Our greatest worries… would be a cancer patient’s greatest dreams.

“We are in medical school now. We are all going to be doctors. We have absolutely nothing to complain about.”

As Harry completed his speech, he realized that Daphne, Hermione, and Igor were staring at him. Ron excused himself to “go to the bathroom.” The awkward silence stretched on. Minutes dragged by. Harry was just about to leave and get some real work done when Ron reentered the classroom with his tablet in hand.

A chill ran down Harry’s spine. Ron’s ears had turned a bright shade of red.

Erythematous macules? The nugget of knowledge burst forth without any voluntary summons from Harry’s brain. First sign of measles. The preliminary form of the morbilliform rash, to be exact. He might be contagious.

“Ron, are you sick?” Harry asked.

Ron glanced through the windows. After a lone pedestrian had crossed to the other side of the road, he beamed widely at his audience.

“I just made medical school history,” Ron said, posing in the doorway with his hands on his hips. “I’m going to be famous.”

“That’s great, Ron,” Hermione said. “What did you do?”

“I failed Medical Humanities.”

***

Afternotes:

If you liked this Harry Potter-themed short story about medical school, you may also enjoy its predecessor, The Voldemort Lab.

This short story draws upon a scene from Harry Potter and the Half-Blood Prince. For the excerpt, see this link.

Medical Humanities and its successor, Science of Mind and Body, were some of the highlights of my first semester at medical school. I would like to thank all of our humanities instructors for encouraging us to express ourselves through writing.

After a successful orthopedics/rheumatology/dermatology exam, I am looking forward to another week of relaxation before delving into the realms of hematology and cardiology. In the meantime, have a wonderful holiday and Happy 2015!

First Winter

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On the evening of December 10th, 2014, I was scheduled to meet a pediatric resident at a restaurant for dinner. At that moment, I had only four minutes to spare. I threw on a lightweight jacket, thundered down two flights of stairs, burst through the back door, and then –

I stood in the doorway, blinking the haze away from my eyes. For a moment, I wondered why I could not see clearly. Millions of white flecks fluttered down from the dark sky. I admired how the miniscule crystals melted instantaneously on my glove, leaving nothing but cold beads of water.

It was snow.

IMG_1574

The midnight view from my bedroom window, with flash.

That night, I stayed up long past a reasonable bedtime in the darkness of my bedroom, gazing out the open window. With a crisp breeze in my face, and snowflakes falling over my fingertips, I took pictures of the landscape I had come to know so well, transforming before my eyes.

Dawn view from my bedroom window.

Walking to and from school was the highlight of my week. I bypassed as many sidewalks as I could, opting instead for the lawns blanketed with snow. I had forgotten how snow felt under my feet – firmer than cotton, softer than bread, best described as a sea of glass wool. I was late for my dermatology classes because I took so many breaks to take pictures and throw snowballs at the sky.

The Penn State Hershey College of Medicine campus, in the snow.

The Penn State Hershey College of Medicine campus, in the snow.

The afternoon after the snowfall, I grew tired of dermatology and invited a Californian classmate for a study break. We ran up the hill behind our school and threw snowballs at each other for 45 minutes.

What a sight we must have been – two Californians running amok on melting snow, and fumbling with an amorphous structure that looked more like a mound over a grave than a snowman.

A Californian "snowman."

A Californian “snowman.”

In medical school, I have had the opportunity to enjoy snow. Last year, when I was on my medical school interview tour on the East Coast, I never once bothered to touch snow. It would have been unwise to throw snowballs with polished interview shoes and a freshly pressed interview suit. Instead, snow became a substance to be feared, something that could soak through coats and cancel entire interview schedules.

This year, snow regained some of its novelty. I approached snow with the same fascination as I did during my first encounter with a snowman sixteen years ago, off a narrow twisting path in the mountains of Santa Barbara.

In the midst of our dermatology unit, I felt like a kid again.

 

Aftermath of The Voldemort Lab: A Drama in Two Parts

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SCENE 1

A college-aged woman, CAVEGIRL, sits on an unmade bed, staring off into space. NORMAL PERSON enters the room and frowns.

NORMAL PERSON: You look… downtrodden today.

CAVEGIRL: Thanks.

NORMAL PERSON: Why so glum?

CAVEGIRL: (sighs) I worked so hard for that linear algebra class and I got a 107.4% on the final! And a 99.4% overall score in the class! Can you believe it? And guess what? I still didn’t get an A+! After all of that effort… everything has gone to waste!

NORMAL PERSON: Yeah, yeah. Can we play Lego Harry Potter now? I’m Hermione. You can be Hagrid.

CAVEGIRL and NORMAL PERSON exit.

SCENE 2

CAVEGIRL and NORMAL PERSON enter the room and settle into office chairs, facing each other across the table. The floor on CAVEGIRL’s side of the room is strewn with mud-streaked woolen socks; NORMAL PERSON’S side of the room is pristine.

CAVEGIRL: I finally got my grade back from The Voldemort Lab practical exam.

NORMAL PERSON: Hmph.

CAVEGIRL: Guess how I did!

NORMAL PERSON: A hundred, I bet. (grumbles incoherently)

CAVEGIRL: Nope. Lower!

NORMAL PERSON: Ninety-nine, then.

CAVEGIRL: Lower.

NORMAL PERSON: Eighty-nine.

CAVEGIRL: Lower.

NORMAL PERSON: Seventy-nine?

CAVEGIRL: Lower.

NORMAL PERSON: (eyes wide) Cavegirl! Sixty-five?

CAVEGIRL: (smirking) Lower.

NORMAL PERSON: (screaming) CAVEGIRL!!! You – no, REALLY? You fail – no – are you jok – WHY ARE YOU STILL SMILING?

CAVEGIRL: Because the pass mark is 60. The scores were historically low this year. And I passed with four points to spare! So chill.

NORMAL PERSON: (muttering) I wish I was in… (incoherent)… medical school. You get to… (incoherent)… Pass No Pass! While I’m stuck here… (incoherent)… A’s and B’s and C’s! Grmph.

CAVEGIRL blows NORMAL PERSON a kiss. NORMAL PERSON scowls and vanishes into thin air, leaving a dark glass screen where her chair used to be. CAVEGIRL exits.

 

The Voldemort Lab

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Homaira’s Note: The majority of this piece was written on Tuesday afternoon (November 11th) from the obscure depths of the Penn State Hershey Health Sciences Library. Our class had an exam this morning.

To be taken with a cauldron of salt

The new 24/7 medical student lounge reminded Harry of another place he had known during his stay at Hogwarts School of Pre-Medicine. The blinds on the windows were shut tight, so as to protect innocent passersby from the discomfiting sight. The room was saturated with the unique scents of procedures gone wrong, in addition to the rumble of frantic students flipping through grease-stained manuals lying over puddles of clear, putrid fluid on the metal tables. Harry and his classmates now spent all of their waking hours on the third floor, only steps away from a panoramic view of the rural autumn landscape, but they might as well have been working in the dungeons of Professor Snape’s Potions classroom.

After two weeks of sensory conditioning, the sharp odor of formaldehyde no longer bothered Harry; the place only smelled of a bowl of soup that had gone sour after a couple of months on the countertop. When no one was listening, however, Harry liked to call this classroom “The Voldemort Lab.” Halloween had come and gone, and yet there were still severed skins in the cremation buckets and halves of skulls on the dissection tables. Perhaps more bizarre was the fact he had just spent the past ten hours sitting next to a corpse, and still felt an urgent craving for soup – warm, edible, hot-and-sour soup, albeit without the chicken.

Peering into his anatomy atlas, Harry deduced that he was the most clueless student in the entire first-year class. He turned to consult his lab partners, but was unduly interrupted.

“What in the name of shiitake mushrooms is that?” asked Ron, pointing at an indecipherable network of red, yellow, white, and pink fibers lying inside the cadaver’s wrist. It might as well have been a map of all the streets, sidewalks, and hiking trails in the world, condensed into the area of a wristwatch.

“Flexor digitorum profundus, lying deep to flexor digitorum superficialis,” said Hermione.

“Bless you,” said Ron.

“It’s Latin!” said Hermione, looking aghast. “It’s possibly the simplest structure to identify in the deep layer of the flexor compartment of the forearm! The tendons run all the way down from the wrist to the distal phalanges of the fingers. The medial half is innervated by the ulnar nerve, while the lateral half is innervated by the median nerve. That’s partially why the thumb, index finger, and middle finger lose function in the event of carpal tunnel syndrome, which primarily affects the median nerve.”

A day's worth of knowledge in medical school.

A day’s worth of knowledge in medical school.

“I’ll take your word for it,” said Ron. With his glove, he brushed aside a globule of fat from the top of the cadaver’s arm. It landed on his own mint-green scrub trousers, and stuck there like a leftover bit of Mrs. Weasley’s egg pudding. Harry resolved never to eat pudding again.

Ron seemed not to have noticed. Pointing at the cadaver’s arm, he continued, “This is all we need to know, in my humble opinion. After all, it’s humerus.” He paused as his eyes fell upon Harry’s nauseated expression. “What’s wrong, Harry?”

Ron seems to find this structure humerus.

Harry swallowed, purged his mind of all food-related memories, and pointed at his atlas. “I don’t think I have enough space in my cerebrum for all of these names.”

“Relax, Harry.” Ron leaned against the dissection table, smearing cadaver grease from his glove onto the communal dissection manual. “I would say you know enough about the leg – “

“I’m worried about the foot,” Harry said quietly. He flipped through another five pages of paintings showing countless layers of foot musculature and vasculature, then slammed the atlas shut with a thud that caused Hermione to jump from her stool with her scalpel still in hand. “Although the leg isn’t trivial, either.”

“No, but it is tibial,” Ron said.

Harry decided to direct his question specifically to Hermione.

“Hermione, I can’t find the great saphenous vein – which side of the leg is it on?”

Without a moment of thought, Hermione rose from her seat, extracted a dark red vessel from the skin of the cadaver’s medial ankle, and held it up for Harry to press in between his fingertips.

In response, Ron remarked, “Sometimes I think that all my merrymaking is in vein.”

Hermione glanced askance at Ron’s expectant grin, sighed, and returned to scraping off the fatty tissue from what she called the “median nerve.”

Harry, on the other hand, went back to staring at his diagrams of the foot and the hand. He knew that if he got “flexor digitorum longus,” “flexor digitorum brevis,” “flexor digitorum profundus,” and “flexor digitorum superficialis” mixed up on the practical exam, he would be toast. Who knew how his discombobulated wand would backfire this time?

***

Afternote: This short story was inspired by a single social exchange from Harry Potter and the Goblet of Fire. For the original scene, see this link.

 

Autumn Leaves: Memories from an Unusual Weekend

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Two weeks before my 12-week Scientific Principles of Medicine (SPM) exam, I spent my evenings reading Harry Potter fanfiction, and my leftover free time studying for the exam that I should have started preparing for 7 weeks previously. Naturally, one week before the big exam, I had to reverse that pattern.

With my propensity to over-stress about everything, I woke up at 5 AM on October 31st, the Friday of the exam. I studied cancer biology and immunology for 3 hours before leaving my apartment.

On my way to campus, I noticed that the sidewalks were quiet and empty. Normally, there would be students streaming out of their apartments by this time of day, frantically flipping through binders of notes and mouthing the biological targets of antifungal medications. I grew more fearful by the moment – had I misread the exam schedule? Was I late? Was the entire class already struggling through free-response questions that asked us to recite the life cycles of all known parasitic flatworms from memory?

How I felt the morning of my SPM exam.

When I arrived, there was no one in the lecture hall except for two proctors and two medical students. I was half an hour early.

On the other side of the spectrum, one student arrived five minutes after the proctor began reading aloud the instructions for the electronic exam. The rest of the class, including the proctors, watched him in utmost silence as he climbed down the steps of the aisle to retrieve his designated scratch paper.

In any case, the exam went well. I flunked the immunology multiple-choice questions and still managed to pass with a decent overall score. To celebrate, I treated myself to a lunch of vanilla frozen yogurt with chocolate chips, white chocolate chips, and peanuts. When a classmate asked me about my impersonation plans for Halloween, I proudly announced that I would be a narcoleptic.

Featured above is Ledroptha Curtain, the narcoleptic villain from a sci-fi novel that nearly made me fail a chemistry midterm as a freshman in college. Because of his narcolepsy, Mr. Curtain often falls asleep halfway through his diatribes.

***

During the metabolism block of our SPM course, I discovered that straining my brain did not burn nearly as many calories as exercising my skeletal muscles.

From Californian karate student to PA medical student.

I took my metabolism professor’s advice to heart and contacted three fellow first-years who were interested in practicing karate on weekend mornings. We dubbed ourselves “The Ninja Team.”

The weekend after our SPM exam, however, I decided that our recent accomplishments warranted a change in routine. Moreover, I had never seen autumn leaves before – watching trees turn brown from the comfort of the medical student lounge did not count – so I decided to invite my Ninja Team friends for a hike up the mountains near Harrisburg.

On Sunday morning, Siri warned me that the weather outside was “BRRRR!!!!” cold (37 degrees Fahrenheit) and windy. After searching my closet, I found only a business-worthy winter coat from last year’s medical school interviews in the snow. As an alternative, I decided to wear a couple of additional cotton layers underneath my everyday clothes. At 8 AM, I picked up my fellow Ninjas and drove 30 minutes to the trailhead of the Appalachian Trail.

As it turned out, the wind was murderous – 30 miles per hour, with gusts of up to 50 miles per hour. The wind quite nearly swept us off the mountain. I had underestimated the power of wind to sap away every ounce of our lung capacity.

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Climbing up the switchbacks against the wind.

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An oasis of calm: this flat portion of the trail was shielded from the wind. We paused here to catch our breath.

Even through misty eyes and streaming nostrils, I savored the pristine landscape stretching on into the distance.

lunchtime

We had lunch at the Peter’s Mountain summit. The sun began emerging from behind the clouds.

Photography, however, also became my downfall. With autumn leaves blanketing the forest floor, it was easy to overlook potholes and unstable boulders along our path. Numerous times, we found ourselves ankle-deep in forest mulch, besieged by thorns and bracken, and without a hint of a trail in sight.

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The Susquehanna River.

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Climbing down the mountain, I paused to admire the sun and the autumn leaves.

As we were driving home, one of my friends remarked that we had earned our titles as Ninjas because no one in their right mind would have tried to hike up a mountain in 50 mph winds. She was probably right; I decided not to mention the wind part of our adventure to my mom over the phone.

Only a couple of hours after we returned to Hershey, it was time to don our hospital scrubs and meet our cadavers for the first time. After a weekend of adventure, I had absolutely no idea what was in store.

 

 

 

 

The Caseating Cheesecake

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Homaira’s Note: Earlier, I accidentally pressed the “Publish” button before this post was ready. The post below is the final version.

As a culminating project for our 12-week Scientific Principles of Medicine class, the first-year medical students were asked to cook special meals that would be suitable for individuals with various metabolic diseases. Our 8-member PBL group was assigned to maple syrup urine disease (MSUD), an inherited disorder that affects a person’s ability to break down proteins from the diet.

Naturally, we decided to bake a Low-Protein Cheesecake. The only caveat was that I couldn’t (and still can’t) cook or bake anything that looks socially acceptable for human consumption. I therefore assigned myself to the presentation part of the project, because we would have to convince the judges of the superiority of our group’s dish.

Considering my artistic and musical deficiencies, I decided to draw upon some of my own creative interests. While my teammates were baking away, I lounged on the couch with my laptop and concocted a speech.

The following morning, I pre-tested my performance on some medical school interviewees before heading off to class. In the lecture hall, I watched as the representatives from the other 3 MSUD groups listed their ingredients and gave brief summaries of their procedures. When it was my turn, one of my teammates held up the cake for the audience to admire while I began my solemn speech:

Presented by the Penn State Hogwarts PBL group

Presented by the Penn State Hogwarts PBL group

“We have something cheesy

This project was just breezy

Welcome to our feast

You’re here for scrumptious treats!

Though it’s tasty, never fear,

MSUD friends have cause to cheer!

This time we made a special cake

The cheese today is light and fake

Low in protein, high in fun

This concoction is number one.

 

We first begin the crust

And build atop Graham cracker dust

And sticks of butter are a must.

 

Second is a filler

The part that is killer

Coffee, cool whip, marshmallows double

Turned this pretty cheesecake supple.

 

Third’s the topping,

and then I’m stopping,

Raspberry filling

and kiwi ceiling

A touch of chocolate

This cake will rock it.

 

Our team has baked

The Caseating CheeseCake – “

My dramatic pause was punctuated by the uproar from the audience. Undoubtedly, I had reminded them of our Infectious Diseases unit in vivid detail:

caseous necrosis

Caseous necrosis: a cheesy deposit of dead tissue encountered in the lungs of tuberculosis patients

“Wait, I’m not done yet!” I waited another ten seconds for the commotion to subside.

At this moment I divulge

And thus I leave you to indulge.”

With a flourish of my hand, I bowed to the audience and returned to my seat. Meanwhile, the five judges were hard at work, tasting each of the four MSUD dishes in turn.

As the judges made their choices, there was a drumroll from the audience, and…

Winner!

Our group received 3 out of 5 votes for the best dish in the MSUD category.

Low in protein, indeed.

Low in protein, indeed.

So thus, after a morning of fun,

I must get a boatload of studying done.

 

 

Dreams of Danger

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Updated 10/23/14

When I first started writing this Hogwarts blog, I was new to the Hershey area. Late at night in my apartment, I felt restless in a “foreign” bed that was unnervingly soft, and much taller and deeper than the one I had slept on for the past fourteen years. In that altered state of consciousness between sleep and wakefulness, I imagined that I was Harry Potter, boarding the Hogwarts Express train for the new school year. However, instead of shipping me off to the Hogwarts School of Witchcraft and Wizardry in rural Scotland, the train morphed into a submarine, traveled underneath the Atlantic Ocean, and dropped me off in rural Pennsylvania. Once I arrived, I traded in my black Hogwarts Pre-Medicine robes for a long, flowing set of snow-white doctor’s robes, with hems that fluttered gracefully around my ankles.

There was just one caveat. Harry’s six years at the original Hogwarts were primarily devoted to a class called “Defense Against the Dark Arts” – magical self-defense! Why would Hogwarts College of Medicine be any different?

Watching through Harry’s eyes, I stepped onto the campus lawns and immediately saw what I needed to achieve before entering the school – the last, previously undisclosed challenge of the admissions process, so to speak.

dragon had been stationed as a guard at the front entrance. A five-hundred-foot-tall, scaly, spike-ridden, fire-breathing dragon.

The Hungarian Horntail from Harry Potter and the Goblet of Fire

The Rite of Passage

The Rite of Passage

To claim my spot as a student of Penn State Hogwarts, I would need to skirt around the dragon’s massive legs, somehow, with only my nerves and my purple stethoscope for self-defense… and without scorching the seat of my brand-new white robes in the process.

At that point, I could not have thought of a more exhilarating scenario to contemplate before drifting off to a deep slumber.

Alas, there was no dragon waiting for me at the College of Medicine’s main entrance the following morning. A couple of months later, however, I have finally met the very first “dragon” of my medical school career: the final exam for our 12-week Scientific Principles of Medicine Sorcerers’ Perspectives on Medicine class.

 

 

The Fractals of Memory

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As our first real class in medical school draws to a close, I am faced with the intimidating prospect of memorizing hundreds of pages of notes from the past eleven weeks. I’ve done similar things before, all throughout my teenage years, but this time feels very different; maybe it’s because I’m finally tackling this challenge after more than two decades of absentminded dreaming.

The following excerpt from my ongoing science fiction novel reflects how I wish my memory would behave over the next two weeks, as I begin to review the vast realms of biochemistry, molecular biology, genetics, immunology, microbiology, and infectious diseases.

A coriander fractal

A little background for those of you who are unfamiliar with my story: Willow, the main character, is a sixteen-year-old college student traveling with a wilderness expedition of nomadic chemists in search of new energy sources. Willow has a knack for identifying wild plants. Jedediah, a postdoctoral fellow in the expedition, shares an office tent with Willow while they are not in active transit.

***

“You would be a good doctor,” Jedediah said.

I choked on my cough syrup.

“It’s true,” Jedediah insisted. “You would be a good doctor.”

“Me? Why?”

“You don’t provoke other people’s wrath. Irritation, sometimes, but never wrath.” Jedediah scowled at the mud-streaked paper plate that River had abandoned on his desk. “That can’t be said of other people I know, who just can’t keep their mouths shut when their own ego is at stake. But there’s more to it than that. It’s how you absorb complex details. Think about all of this plant taxonomy shenanigans you’ve managed to learn, for example.”

At Jedediah’s prompt, I did think about it. I thought about how I relished the thrill of large maps of names and characteristics seeping into my mind; how I could zoom out to examine only the most prominent branches of the massive tree, and then soar into its depths as much as I liked – an infinitely deep fractal, a flawless snowflake, or the vast night sky. Delving into the image in my mind brought forth yet another layer of intricate maps, upon maps. When I sat down at my desk to learn, I felt as if I was floating freely in deepest space; engulfed in light, upon light, and immersed in the ever-expanding grandeur of the natural world.

“But I can’t learn by hearing anything once, or even twice,” I said quietly, shaking my head. “I have to spend hours with the material, and map it out carefully on many sheets of scrap paper taped together…”

Jedediah shrugged. “I wasn’t saying that you were a genius. But some fools are geniuses, and all geniuses are fools; therefore, by logical deduction, the remaining fools must compensate for the inadequacy of geniuses by completing projects that are, or were, ingenious.”

I bowed my head for a brief moment. “Whatever you say, Jedediah.”

Divinating Histology – Another Harry Potter Parallel

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Today, I was daydreaming about the (mis)adventures that Harry, Ron, and Hermione would have if the magical subject of Divination (predicting the future) was brought to our Histology classes at Hogwarts College of Medicine.

At the Hogwarts School of Pre-Medicine, third-year students learn to predict the future by gazing into a crystal ball. At Hogwarts College of Medicine, first-year students learn to identify various tissue types by gazing into a Slide. It seems almost natural to combine the two subjects…

Intent crystal-gazing and delving into the superconscious

“Tissue gazing is a particularly refined art,” Dr. Trelawney said dreamily. “I do not expect any of you to Identify when you first peer into the Slide’s infinite depths. We shall start by practicing relaxing the conscious mind and external eyes, so as to clear the Inner Intuition and the superconscious. Perhaps, if we are lucky, some of you will Identify before the end of the class.”

And so they began. Harry, at least, felt extremely foolish, staring blankly at the pink tissue specimens on his PowerPoint slides, trying to keep his mind focused when thoughts such as “They all look the same” kept drifting across it. It didn’t help that both Ron and Hermione, and everyone else in the lecture hall for that matter, seemed to recognize the difference between simple cuboidal epithelia and simple columnar epithelia.

“Identified anything yet?” Harry asked Ron and Hermione after a quarter of an hour’s quiet Slide gazing.

“Yeah, I see a Man on the Moon,” said Ron, pointing. “I wonder how he managed to Apparate into a bunch of connective tissue.”

histology face

“This is so frustrating,” Hermione sighed. “Where are the darkly stained nuclei? What type of collagen fibrils are we looking at? Is this dense irregular connective tissue, loose connective tissue, or something else entirely? What organ system is this from?”

Dr. Trelawney rustled past.

“Would anyone like me to help them interpret the shadowy pathologies within their Slides?” she murmured over the clinking of her stethoscope.

“I don’t need help,” Ron whispered. “It’s obvious what this means. This poor patient’s immune system is launching an inflammatory response against parasitic lunar aliens.”

“No, Ron,” Harry whispered back. “It means we’re having salami for dinner tonight. That’s all.”

Both Dr. Trelawney and Hermione looked scandalized.

 

For the original excerpt from Harry Potter and the Prisoner of Azkaban, please see this link.

If you enjoyed this entry and would like to read a prior post that is similar to this one, please direct yourself to A Summary of Our First Week with White Coats.

 

Growing Up

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The Sunday night writing prompt for my Medical Humanities class was simple: Who do you want to be when you grow up?

I had just explored the same topic in the latest entry of my personal journal, so I had no trouble crafting an honest answer:

September 21st, 2014

There are two things I wish to be more than anything in the world:

  1. A competent and caring physician; someone who instigates healing, in every sense of the word.
  2. A writer – someone who can capture all of the dimensions of that beautiful and mysterious thing we call life; and, just like life, make us laugh one moment, and cry with overflowing emotion the next; someone whose words wrap their threads around the deepest depths of our hearts, and never let go.

The writers I remember most from my childhood years – J. K. Rowling, Madeleine L’Engle, Avi, and William Howard Armstrong among them – inspired me by their ability to paint vivid worlds and breathing characters with only pen and paper. As much as I admired them, I never truly valued, or even recognized, my own dream; when I was in grade school, creative writing was never mentioned in the same category as painting, acting, dance, or music. Now, as I begin to share more of my writing with others, I am starting to realize that my childhood dream was a genuine one after all. There is nothing that brings me greater peace and healing than watching my pen flow across the blue lines of a blank page, through the countless miles of uncharted rivers contained within a single notebook.

The series that showed me how simple, accessible writing can also be breathtakingly beautiful

In my life, healing and writing have become interdependent. As a pre-med student, I had the privilege of watching life begin and end; life enduring, triumphing, and simply being. By writing, I can attempt to capture the melody of these moments, through the joy, the sorrow, and even a little of the silliness. When I moved to Hershey two months ago, I thought that the start of medical school would signal the end of my writing. I am pleased to say, however, that I have never been so happy to be so wrong.

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The journal I have kept for the past four years – 154 pages, and counting, about the adventure of my life

Legilimency in Medicine, Part 3: When the Spell Rebounds

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For my previous two posts in the Legilimency series, I approached the subject of doctor-patient interactions from a magical point of view; the doctor/medical student casts the Legilimens spell (a well-conducted interview) on the patient, and the doctor gains insight into the personal circumstances that surround the patient’s health. If you are familiar with the Harry Potter universe, however, you may know that magical spells can often rebound onto their caster. Even Harry, who had no experience in Legilimency, inadvertently caused the Legilimens spell to backfire on Professor Snape, so that Snape found his own mind being read and influenced by Harry. In the medical field, Legilimency rebounds onto physicians almost every day; I will share just two of my recent experiences below.

Backfiring spells at the Hogwarts School of Pre-Medicine. Backfiring events are a little different (and more serious) at the Hogwarts College of Medicine.

This post was initially planned as Part 2.5, but a new event from the past week prompted me to write a complete Part 3. I do caution my readers, however, that this post is a bit more emotionally involved than Parts 1 and 2 of this series. Nonetheless, I believe that such events are a critical component of the student doctor experience.

Names have been altered to protect the privacy of all those involved.

Part 3.1: Last Thursday

We arrived in our small group classroom for another day of Systems Navigation. We would be having our third and last standardized patient for the preparatory unit of this class – a trained actor playing the part of Todd, a middle-aged man recently diagnosed with terminal cancer. I watched three other students take turns in interviewing the patient.

With an impossibly weary, broken voice, Todd related his life story to us: his bittersweet childhood with a disability, his decades-long marriage that was just now dissolving before his eyes, and the many accomplishments of his children that he took pride in. He greatest fear was that he would not live to see his daughter graduate.

As our interview time slot came to a close, Lily, the last student interviewer, asked Todd:

“If there was one thing that we could do for you – what would it be?”

Todd averted Lily’s gaze, opened his eyes wide, and lifted his eyebrows to the ceiling, prompting a sea of wrinkles to appear on his forehead. At that moment, he looked older than anyone I had ever met. His parched, upturned lips clamped tightly together, suppressing the quiver that threatened to escape from within. He sighed deeply through his nose, as if the extra air flowing through his eyes and nostrils could dilute his grief; dry out his tears; or perhaps combust the source of his grief, burning it out of existence. But no matter what we said, as outsiders, we could not take his pain away; we were left to listen, and to wait, with bated breath.

As we watched, Todd’s face turned a deep shade of red. When he looked toward us again, his dark eyes shimmered with tears.

“Tell – “

Lily held her breath.

Then, with the softest plea trickling from his lips:

“Tell me that it’s all going to go away.”

Without warning, Lily lost it. As our professor whispered “time out,” her eyes were streaming uncontrollably. The spell of the mock patient-interview was lifted; and yet, when she tried to laugh, the contractions of her diaphragm emerged only as a tortured cry.

Todd offered Lily a warm hug before leaving the room. I caught a glimpse of the actor setting off briskly down the hallway; he had recovered so readily, while I surely had not. I spent the rest of the afternoon and evening in a stupor. A harrowing day in history had become a crucial day of my life.

Part 3.2: Friday, August 8th, 2014

Since our White Coat Ceremony, a number of real patients have visited our first-year class to speak to us about diseases we have been studying, including myasthenia gravis, type 1 and type 2 diabetes, osteogenesis imperfecta, and phenylketonuria.

Undoubtedly, I’ve learned the most about life from the patient with cystic fibrosis.

I first heard about cystic fibrosis in my second year of undergrad. It was briefly described as a genetic disease that destroys the thin fluids hydrating the internal organs, replacing them with thick, sticky mucus that overwhelms the lungs and pancreatic ducts. Patients often die of chronic lung infection and respiratory failure; there is no cure. I never once considered that cystic fibrosis might be a survivable disease.

And yet it was; and I will never again underestimate the indomitable will of human beings to survive.

This brave young man narrated the remarkable story of his life – of managing chronic respiratory illness throughout his childhood and teens, emerging from the brink of death after receiving a double-lung transplant, and experiencing the joys of raising a family. He inspired me even more because of the silent tears in his eyes. He had survived so much pain in his life – even more emotional pain than the physical pain of scarred lungs – and yet, he was positive enough to laugh through his tears that cystic fibrosis wasn’t “all bad.” He could indulge in all of his favorite greasy foods while his family and friends followed stringent diets, because he would never gain weight.

When our professor invited us to thank the man for his visit, I did not believe that a simple round of applause would do him justice. For a terrifying ten seconds, I was the only one standing in a sea of people. Then, slowly, my neighbors joined me; and like a gentle breeze rippling through a meadow, the rows of medical students rose in a standing ovation that swept my breath away.

I will remember the man with cystic fibrosis as the one who reminded me that healing is possible after a tragedy or severe illness. Additionally, he showed me that tears are an acceptable, even welcome, ingredient of healing. With tears, we can embrace the emotions that make us human; with tears, we can stare down obstacles and summon the right memories to overcome them.

The healing power of tears, as demonstrated by Fawkes, Professor Dumbledore’s phoenix. In the novels, phoenix tears can heal even the most grievous of wounds, including basilisk snakebites.

Conclusion

As my three-part series on Medical Legilimency draws to a close, I would like to make an effort to learn how to speak with people who are experiencing grief or loss. Many doctors specialize into fields that do not involve divulging terminal diagnoses; however, all of us will have to comfort a friend or family member during challenging times. As a student doctor, I now feel a moral obligation to learn how to lead that discussion in a way that promotes emotional healing.

Based on this realization, I recently signed up for a real-life Patient Navigation commitment as a part of my healthcare systems course. Starting in November, I will be working one-on-one with patients at a Harrisburg clinic to understand where they come from, and help them access appropriate healthcare resources. There will be a steep learning curve on my end, I am sure, but I am eager to begin the process just the same. As much as there is to learn from the doctors who came before me, there are entire new dimensions of healing to be learned from my patients.

Finally, to my readers: thank you for following me through a challenging collection of experiences. I would have abandoned this series long ago without your support.

Aftermath of My First Science Exam in Medical School

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I had my first medical school science exam this morning, and I can say the following with utmost sincerity: I had a phenomenal weekend.

For 60 hours, I locked myself in my apartment and delved into the vast oceans of cell biology, pharmacology, muscle physiology, metabolism, and molecular genetics. When I was not in the nebulous depths of slumber, I lay on my bed with more than 200 pages of notes from the past six weeks, and proceeded to memorize everything. I read my notes aloud, rewrote them on sheets of scrap paper rescued from Hersheypark, studied from self-made electronic flashcards, and even sang some biochemical pathways to commit them to memory. (For example, the CAT (carnitine acyltransferase) shuttle in the mitochondria somehow transformed into “Everybody Wants to Be a Cat” from Disney’s The Aristocats… or more accurately, “Everybody Needs to Have a CAT.”)

CAT aristocats carnitine version 2

On both Saturday and Sunday, by the time I finally put the binders to rest and settled down for dinner at midnight, I was quite literally burning from a stress-induced fever. Even as I write this almost nine hours after the end of my exam, I still feel a little delirious.

And yet, I savored every moment of my weekend.

I don’t think I’ve memorized any significant quantity of material for the past two years; my senior year of college was primarily spent in the research lab, and my gap year schedule was partitioned between the lab, the clinic, and an assortment of airports. I’ve now come to realize that I actually missed this adrenaline rush – the uncomfortable wave of warmth pulsing through my ears, the distinct sensation of intertwining diagrams seeping into my skull, even the lingering sweet taste at the back of my throat from stress-induced fasting hyperglycemia. (As I write this, I feel an inexplicable urge to map out the effects of norepinephrine and epinephrine on adrenergic receptors in the sympathetic, fight-or-flight branch of the autonomic nervous system.)

If nothing else, I’ve confirmed one thing: if I’m excited about nonstop studying, I must truly be in the right profession.

UPDATE: I previously forgot to mention that my laptop computer, which I needed to take the secure electronic exam, decided to shut down and go through a Windows Update at exactly the wrong time. Nonetheless, as you may guess, I managed to stay calm and finished my exam two minutes ahead of schedule (on a laptop loaned to me by the proctor.) Phew – all’s well, that ends well!

Legilimency in Medicine, Part 2: Summoning Memories

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Our professor was midway through his introductory lecture on healthcare systems – specifically, on how to help a patient navigate the convoluted catacombs of the healthcare system –  when he was rudely interrupted by someone pounding on the lecture hall’s front doors. He paused to gawp for a moment, but the pounding only grew more insistent; the massive double doors quivered on their hinges.  Dr. W looked flustered.

“Err…” He waved apologetically at the class of 150 first-year students. “Just give me a moment – “

He approached the entrance; but before he could lay his hand on the door handles, a woman burst inside – a woman wearing short gym shorts and a sports jacket, in sharp contrast to all of the medical students in ties, dresses, and white coats. Her tousled hair jutted out in all directions, her eyes were locked tight, and her face was contorted into a tearless wail.

“I need to see my doctor, I need to see my doctor!” Her eyes flitted throughout the lecture hall in obvious desperation. “Is my doctor here? I thought I heard his voice on the microphone – “

Dr. W stood motionless while an older lady, a nurse from the medical center, rushed down the aisle of the lecture hall to greet the wailing patient.

“Er, could this be done somewhere else?” Dr. W began tentatively. “We’re in the middle of lecture.”

Neither the patient nor the nurse paid any heed to Dr. W’s quiet plea. Meanwhile, the rest of the classroom simmered with poorly-hushed whispers. Some students could hardly contain their laughter. My neighbor and I exchanged incredulous looks. After numerous classroom antics (refer to my post on “Professionalism”), the pupils of Penn State Hogwarts knew better than to regard all of their classes with utmost seriousness.

We watched as the nurse calmed the patient down and led her to the front of the lecture hall. They decided to have a “private” conversation right there, since two empty chairs were conveniently ready for them.

At this revelation, Dr. W startled. He unclipped the microphone from his chest pocket and offered it to the patient. “Could I give you this microphone so the students can hear you too?”

The muffled snickers around the classroom erupted into laughter; however, the energy promptly faded away as the “patient” unraveled her story, aided by copious wads of tissues (kindly supplied by Dr. W). Her character had just been diagnosed with breast cancer, and was so overwhelmed that she had run away from the radiologist before hearing her full diagnosis.

After listening to the patient’s story, the nurse began speaking calmly, quietly, as though she were whispering a lullaby. She explained the recent advances in cancer treatment, and assured the patient that support would be available through challenging times. Most importantly, the nurse emphasized the positive aspects of the patient’s story, especially that she had a loving family who would care for her through her illness. By the end of the interview, the patient’s breathing had steadied, and she was even beginning to smile.

I had watched countless such soothing conversations before, but only this one gave me reason to sweat profusely in my seat. We would be expected to conduct a similar interview the following week, and I already knew from my first disastrous Clinical Skills class that speaking to a patient was not always an intuitive task.

At the end of the show, the actress wiped her tears on a handful of tissues and waved merrily at the audience. With the spell broken, the classroom returned to its baseline level of rumbling and whispering. Nonetheless, my mind remained restless.

How do you talk to a patient going through unimaginable challenges? Our Sorcerers’ Perspectives Scientific Principles of Medicine class is consuming the vast majority of our first semester, and yet, for all its convoluted diagrams on hypoxanthine-guanine phosphoribosyltransferase deficiencies in Lesch-Nyhan syndrome and gamma-carboxy glutamate residues in the synthesis of blood clotting factors, biochemistry doesn’t teach us how to wriggle out of treacherous patient interviews. I guess that’s why we have classes on Medical Humanities and Healthcare Systems Navigation…

One week after the wailing patient disrupted our Healthcare Systems class, I was one of the first students to volunteer to interview a standardized (actress) patient in front of my small group. The moment this lady walked into our room, I was mesmerized by her character; she spoke with a voice that was unbelievably weary, sounding as fragile as a butterfly’s wing. She had a long history of chronic medical problems, as well as family-related instability. She told me, “I feel that I’m such a burden to my family. I can’t do anything for them. I can’t cook, I can’t drive, my treatment is taking over my life. I’m such a burden…”

I was dumbstruck and tongue-tied. I didn’t know how to reassure the patient, as the nurse from the previous week had done by emphasizing the wailing lady’s supportive family. I realized then just how accurately Professor Snape had described the essence of Medical Legilimency:

The mind is not a book, to be opened at will and examined at leisure. Thoughts are not etched on the inside of skulls, to be perused by any invader. The mind is a complex and many-layered thing… those who have mastered Legilimency are able to interpret their findings correctly…”

Mind-reading in medicine is not as important as the interpretation of that priceless information, and summoning the right memories into the forefront of the patient’s mind. This process can help the patient shovel out the topmost layer of pain and loss to remember the little things – all the giggles and birthday parties and strolls in the woods…

In other words, summoning the right memories is the key to healing. If I can only manage to master this skill over the next four years, I will be very well prepared to practice medicine.

To be continued in Legilimency in Medicine, Part 2.5: Summoning Memories, Continued

Legilimency in Medicine, Part 1

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Based on the events of August 12th, 2014

 “Only Muggles talk of ‘mind reading.’ The mind is not a book, to be opened at will and examined at leisure. Thoughts are not etched on the inside of skulls, to be perused by any invader. The mind is a complex and many-layered thing, Potter… or at least, most minds are.” He smirked. “It is true, however, that those who mastered Legilimency are able, under certain conditions, to delve into the mind of their victims and to interpret their findings correctly…”

 – Severus Snape, Harry Potter and the Order of the Phoenix

For all of Professor Snape’s pretentious speeches, the art of Legilimency was never actually taught at the Hogwarts School of Pre-Medicine – there was only some hodge-podge about resisting mind-reading through emotion-blocking training (Occlumency). Throughout all my years of reading about Harry Potter’s disastrous Occlumency lessons, I always wanted J.K. Rowling to get to the meat of the matter and teach us Legilimency… that way, Harry would be able to mind-read answers to questions off of Hermione and pass his History of Magic exam.

Naturally, I was pleased to find out that “Legilimency” is a significant part of the Penn State Hogwarts College of Medicine curriculum. As modern magical medical students, we are expected to ask patients about their lives without actually telling them what we’re looking for. For example, we would ask, “I’ve heard you’re not feeling well,” or even better, “What can I do for you?” instead of, “When did your chest pain start?”

In our preliminary clinical skills training, we were instructed to allow the patient to talk, maintain eye contact, and above all, listen without interrupting the story. The concept assumed that patients would often tell us what we needed to know, without being bombarded by dozens of close-ended questions, if we only granted them the chance to speak freely. In the process, we would also gain valuable insight into the personal, cultural, and socioeconomic circumstances that influenced their health.

Having observed hundreds of patient interviews over the past year as a clinical scribe, I thought that leading a patient interview was going to be a walk in the park. I was the first student to volunteer in front of an audience of two senior physicians and nine first-year medical students.

I began the interview in high spirits. I introduced myself to our lady patient and said brightly, “What can I do for you today?”

The patient sighed. “I have chest pain.”

“Okay. Could you tell me more about that?”

Our patient described her problem in about 1.5 sentences and stopped to gaze expectantly into my eyes. An awkward silence developed between us while I waited for her to say more and simultaneously attempted to construct a mental list of meaningful open-ended questions.

“Could you tell me more about what the pain feels like?” When she sat in her chair and stared, I offered some options. “Does it feel dull, or – “

“It’s dull.”

I tried to conjure up an open-ended equivalent to “How severe is your pain?”, but I could not think of one. Instead, I asked her, “Could you tell me more about why you’re worried about the pain?” I was aiming toward a discussion of her family history.

“My husband was worried about it, so he asked me to come in.”

The entire interview continued on for an excruciatingly slow fifteen minutes. I had been trained to listen to a talkative patient, but I had no idea how to manage a reticent one. I was constantly scrambling to think of questions without spoon-feeding her the answers, or resorting to a relentless onslaught of yes-or-no questions reminiscent of the ER (“Has the pain gotten worse over the past hour? Do you have any personal or family history of hypertension, type 2 diabetes, or high cholesterol? Have you had anything to eat within the past hour? Are you a heavy drinker?”). Since I was interviewing a standardized patient (an actress), and not a real patient, I called “time-out” on numerous occasions and beseeched my classmates for advice.  The entire experience was mortifying, but my professors had expected worse; in fact, they were pleasantly surprised to see that a student had volunteered to interview a patient.

The next stage of the patient-encounter experience was the patient chart. This part should have come easy to me, I know – I’ve lost count how many patient charts I’ve filled out over the past year of my life – but when I sat down to write what I had learned about the patient, I was appalled to find that I didn’t remember much. I had been so focused on formulating questions and trying to look attentive and professional to my patient that I had forgotten all of the details of the interview. I jotted down the patient’s medical problem in the Chief Complaint section – “Chief Complaint: right-side chest pain.”

I glanced nervously around the room; my classmates had already filled up their charts with flowing paragraphs of gorgeous handwriting. I looked back at my single line of text and sighed. My classmates soon completed their write-ups and turned them in to the pile; I scribbled down a couple of last words and handed mine to my professor just as he was leaving the classroom.

My mind slid into hyperdrive on my walk back home, replaying all the events of the day that I simply wanted to forget –

“Hold on. Chest pain – the heart’s in the center of the chest but tilts toward the left side – “ I pictured the patient with her finger over her chest, tracing the route of her pain, “– and she had her hand over her chest across from my right side, which would be her left – “

At that moment, I might as well have overdosed on my legendary 100% Pure Hot Sauce Soup – I felt sick to my stomach. After a couple of hours of moaning and absent-minded demolition of chocolate-coated almonds, I presented the issue to my mom.

“Ammu, I did something really awful today!”

“What happened?”

“I mixed up my patient’s left and right sides on her chart but that’s stupid because why would cardiac pain be restricted to the right side and we just had a whole class on wrong-leg amputations last week and now my advisor’s going to think I’m a complete idiot and – “

My mom laughed until tears streamed out of her eyes. To re-sensitize the mood, my sister pulled out my purple stethoscope and listened for my mom’s heartbeat. It was there, of course, right where it should have been. When she placed the chestpiece on my chest, however, Nashat frowned.

“I’m sorry, Homaira, I don’t think you have a heartbeat,” Nashat said solemnly, after a minute of focused searching.

I forgot all about the disastrous writing assignment until the next afternoon, when my advisor emailed me his comments as an attachment. I hastily archived the message before I could read any of it.

The following day, I forced myself to open the attachment on my phone while I was walking home from school. I scanned through my muddled handwriting and found a single comment scrawled at the bottom of the page:

Good

I concluded that my first patient interview had not gone too badly, after all; but I also knew that this session was only the beginning of our training as professional Legilimens. Our classes on medical humanities, healthcare systems, and Sorcerers’ Perspectives on Medicine all feature cleverly disguised lessons on Advanced Medical Legilimency.

And unfortunately, even accomplished Legilimens can’t always mind-read straightforward answers to the mysteries we encounter every day in the clinics…

Descending the corridors of the Hogwarts dungeons, and into the depths of a patient’s mind…

A Summary of Our First Week with White Coats

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To be taken with a cauldron of salt

Monday, August 4th, 2014

Ron sniggered. “I love medical schoolWe’re going to be getting free time this year. Whole periods where we can just sit up here and relax. We’ve got a free afternoon today… and a free afternoon tomorrow… and the day after… excellent.”

“We need that time for studying, Ron!” said Hermione, as they set off down the corridor.

“Yeah, but not today,” said Ron.

Thursday, August 7th, 2014

As Hermione had predicted, the free periods scheduled for first-year medical students were not the hours of blissful relaxation Ron had anticipated, but times in which to attempt to keep up with the vast amount of homework they were being set. Not only were they studying as though they had exams every day, but the lessons themselves had become more demanding than ever before. Harry barely understood 2% of what Dr. Pomfrey said to them these days in their new course, Sorcerers’ Perspectives on Medicine. Even Hermione, who started out each lecture by scribbling madly onto the pre-loaded slides with her tablet stylus, acknowledged the halfway mark of the two-hour class by shutting down her tablet and staring in a silent, wide-mouthed stupor at the projector screen for the rest of the session. She only emerged from her altered state of consciousness when Dr. Pomfrey shut down the presentation and said, “Any questions?” to a classroom full of delirious students.

Harry frequently looked over at his classmates in the lecture hall or in the Great White Tent to see them purple in the face and straining as though they had overdosed on U-No-Poo; but he knew that they were really struggling to comprehend the assembly and disassembly of clathrin, COPI, and COPII-coated vesicles. It was a relief to get outside to the neighborhood clinics; they were dealing with more challenging patients than ever in Care of Magical Humans, but at least they were allowed to commiserate together after a blood pressure cuff fell off the patient, or an inadvertent tap against the stethoscope’s chestpiece sent shockwaves of gunfire blasting through their tympanic membranes.

“Just call them ‘eardrums,’ now that we’re out of the clinic, will you?” Ron snapped at Harry on their walk home that day. Clearly, Ron was still flustered from the experience of wrongly diagnosing gangrene in an 85-year-old man.

For those of you unfamiliar with Harry Potter lore, you may read the original excerpts from Harry Potter and the Half-Blood Prince here.

The White Coat Ceremony

My classmates and I spent the past week working on our student oath for the White Coat Ceremony. I volunteered to be one of the twenty representatives who compiled our class’ ideas into written form for the final oath. As an added perk, I was also allowed to escape the murky depths of the back row (universally reserved for the poor souls with last names beginning with Ws, Ys, and Zs), and lead the oath at the front of the class.

White Coat Ceremony

An Oath for Our Medical Journey

Today, we the Class of 2018, embark upon our medical journey. To our patients, our communities, our colleagues, our profession, and ourselves, we make these promises:

To Our Patients
We promise to listen with open minds and open hearts,
to teach and to learn.
We will advocate for all persons,
by serving the individual and upholding human dignity.
We will practice with compassion and preserve our empathy,
to guide and be guided by you.

To Our Community
We promise to be mindful leaders,
to collaborate and to serve.
We will share our knowledge, enthusiasm, and spirit,
through open channels with those around us.
We will strive for social justice,
to foster a healthy society.

To Our Colleagues and Our Profession
We promise to maintain a lifelong curiosity,
to dedicate ourselves to innovation and discovery.
We will rely on the strengths of our peers,
to transcend the boundaries of our own abilities.
We will build relationships founded upon respect,
to share mutual responsibility in maintaining the ethics of care.

To Ourselves
We promise to hold ourselves to the highest standard,
to always strive for greater proficiency.
We will balance the many facets of our profession,
by caring for our patients, our families, and ourselves.
We will maintain awe for the gravity of our responsibility,
to conduct ourselves with dignity and courage.

We will adhere to these promises with humility, self-governance, and genuine desire. We will be grateful to those we serve and those who have served us. We pledge to ourselves, and all who can hear, that these promises will guide us on our medical journey.

 

After the ceremony, we treated ourselves to Hershey’s Kisses. My dad and I spoke to the senior Dean of the medical school, the Head of Ravenclaw Waldenhausen Society, Professor Quirrell, and Professor Dumbledore. (With the exception of our senior Dean, whom you can see here, you may check out the portraits of all of the professors at The Sorting Ceremony.)

The Caramel and Special Dark varieties are my favorites!

 

And thus our medical school journey began – with a bit of chocolate in our pockets and a gold Humanities in Medicine pin on our collars, we headed home to enjoy our last weekend before the start of the semester.

 

 

White Coat without stetho 2

During the keynote speech, we were advised to wash our white coats a couple of times over the next four years.

 

Teamwork Part 4: The importance of breaking the rules

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Based on the events of July 28th, 2014

When I came home today, my sister asked me whether I had done any work at medical school. Over the past few days, she had been disappointed to stay home and finish calculus and physics homework while I was solving logic puzzles and escaping from tsunamis.

Today I answered, “I played with Legos.”

My sister scowled. “This is medical school? Are you sure it’s not kindergarten?”

“No, seriously,” I said. “I have a picture to prove it.”

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The essence of the first-year curriculum at Hogwarts College of Medicine. At least, for one hour on Monday.

In this scenario, there were 7 people in our team: 1 builder, 1 guide, 1 Game Master, and 4 observers. The Game Master placed a pre-made Lego sculpture (such as the one pictured above) in front of the guide, in an open shoebox set up much like the workstations in Battleship. The guide was not allowed to touch or reposition the sculpture to observe it from a better angle; additionally, the shoebox concealed the sculpture from the builder’s view.

    

The Game Master then gave the builder the unassembled pieces of the same sculpture that the guide had been given. It was the builder’s job to recreate the structure with the help of the guide; the guide could look at the builder’s pieces, but the builder was not allowed to look at the guide’s sculpture. The four observers monitored the “game”.

There was just one caveat to the activity.

ROUND 1: The guide was not allowed to say anything except for “yes,” “no,” and “I don’t know.”

“Chaos” was the only word for this round. Our builder had to initiate all instruction from the guide with yes-or-no questions, and he was nowhere near completing the sculpture within the five minutes allotted. In a neighboring group, the guide accidentally answered “no” to the builder’s question when she actually meant “yes”, but she was not allowed to convey in plain English that she had made a mistake. The result was a disaster.

ROUND 2: The guide was allowed to say anything to describe the sculpture to the builder.

This round was much less difficult. Being the guide, I was able to take the lead in instructing the builder, instead of the other way around, as it had been in Round 1.

Nonetheless, both rounds were exceedingly frustrating. The game master did nothing for most of the game – but the position of the sculpture inside the guide’s box was critical, since the guide was not allowed to pick up and reposition the sculpture to examine it from a more favorable angle. For example, glancing at the picture I took of the sculpture above, wouldn’t you feel an urge to turn around the sculpture, and see how it was built from the other side?

Now, consider this analogy:

  • Builder = physician
  • Guide = patient
  • Game Master = healthcare bureaucrats who enforce the rules of the system but don’t have to live with its impracticalities on a day-to-day basis
  • Professor Haidet, designer of the simulation = healthcare policy-makers on a national level; Supreme Game Master

Imagine how frustrating it is for the patient to explain their case to the physician, when the healthcare system doesn’t allot enough time, or foster a conducive environment for telling their story in their own words, instead of answering close-ended “yes-or-no” questions for the entire visit. Imagine how much more efficient the visit becomes if the physician is willing and able to listen to the patient’s story, and does not interrupt the patient in the interests of time after only 14 seconds, as is the national average…

As we were about to conclude our discussion about the parallels between The Lego Game and real life, Dr. Haidet said:

“Did any one of you think of just tossing out my rules?”

The class was silent.

Dr. Haidet continued, “Why didn’t anyone say, ‘To h*** with Haidet’s rules!’ and take the sculpture out of the shoebox to show the builder so he or she could build it properly?”

No one in the class had considered that idea. No one had even thought of it. Disobeying The Rule of All Rules – the tried-and-true dictum that you must obey the rules of the game – was not on the radar for law-abiding first-year medical students.

“You are not the future of the healthcare system. You are part of the healthcare system, right now. Recognize that rules don’t have to be followed, that they can be changed. The current healthcare system needs to be changed. All of you can be a part of that.”

To reinforce his own call to action, Dr. Haidet presented the following clip from The Matrix (end at 3:12), where the kung-fu master fights Neo (the guy in the white gi) in a virtual-reality dojo. I have not watched The Matrix, nor do I plan to, but this video clearly summarized the essence of Dr. Haidet’s speech.

I finished explaining The Lego Game to my sister at home after class and concluded with, “See, Nashat? We did work today.”

 

 

 

 

 

Roller coasters and rolling hills

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From the events of July 30th, 2014

Even though I’m supposed to be studying for my first medical school exam on Friday morning (August 1st), I took my sister to Hersheypark for the second time as a belated Eid present.

Our misadventure carried us through afternoon breezes infused with chocolate and freshly-baked churros, corkscrews suspended hundreds of feet in the air, and a near-miss encounter with a real tsunami (overflow from a dramatic waterfall ride).

Fahrenheit at Hersheypark. The roller coaster takes its passengers up a 90 degree “incline” into the sky, and then drops them at an angle of 97 degrees. Braving this ride was my idea.

Storm Runner at Hersheypark. This ride accelerates its riders from 0 to 72 mph in 2 seconds.

If you are inclined to obtain a front-row perspective into the insanity of the Storm Runner coaster, you may find the following video particularly enlightening. (I did not take this video.)

After riding five of these coasters, I felt strangely drained. Later in the evening, I accompanied my parents on a sunset trek to the hills behind my medical school.

It was a striking change from the chaos of crowds, to the idyllic hills where you can actually hear your own steady breathing…

Which experience is truly more exhilarating – to be strapped to a metal contraption that drops you out of the air like a hapless mouse from an owl’s clutches –

– or to gallop up a hill of freshly mowed grass, and soar gently down from the sky with on your own two legs, feeling the currents of air sweep underneath your arms, just as a sparrow would feel underneath its wings?

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The back-door view of our medical school. Standing at the top of the hill, we are at about the height of the fifth floor.

Perhaps the answer is obvious. I prefer the hills.

 

 

Our Class Profile

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Based on the events of July 18th, 2014

On the third day of orientation, our Dean was scheduled to give us a talk about our Class Profile. I had been up late the previous night reading The Murder of Roger Ackroyd (the most brilliant murder mystery in the history of the English language), so after 7 hours of lecture, I was snoozing in my chair, dreaming about an outlandish new sport that involved skiing down grassy hills…

The magic ticket to an evening of flabbergastation and a morning of zombiehood

The Dean arrived a few minutes later. He was the supreme Dean of the school, different from the Assistant Dean who coordinated the Anti-Professionalism demonstrations (see my “Professionalism” post from July 17th).

The Class Profile began just as I expected. I took notes only to keep myself awake.

16 Californians, 16 New Jerseyans, 39% Pennsylvania residents, 61% out-of-state…

Then he moved to a new slide listing all of the life experiences that accepted students had listed on their applications. He read the list out loud to us.

  • EMT
  • Cashier at Walmart
  • Nurse
  • Scribe
  • Worker at Hersheypark
  • Bartender at church nightclub??????

The murmuring in the lecture hall crescendoed to an outburst of hysterics as the Dean approached the incriminating line of text. At this point, the Dean paused and turned toward the audience with the expression of one who had just been ambushed by singing Neptunian aliens.

Bartender at church nightclub?” The Dean repeated. His chest shook with the force of his silent laughter until tears welled in his eyes. “I don’t know what’s more frightening, the fact that you had this experience or the fact that you’re telling me this…”

I silently agreed with him. The only more ridiculous oxymoron I could think of was a “hospital nightclub”… uniting a sanctuary of healing with the breeding ground of all Friday night ER visits…

The next series of slides detailed our class’ collective “Pastimes and Hobbies.” Not surprisingly, there were the sensible answers of “karate,” “cooking,” “baking,” “playing piano,” and “creative writing,” but sprinkled throughout the list were also some unconventional “hobbies”:

  • sleeping (11 people)
  • Netflix (37 people)
  • eating (~20 people)
  • “playing with puppies” – to which the Dean remarked, “That’s too cute. How could I not accept someone who likes playing with puppies?”
  • performing parodies of popular songs while riding on horseback (????????)

Our Dean’s next slide was entitled, “Talents.” About 90% of the students had listed socially acceptable talents, often reiterated from the “Hobbies” section. However, our class primarily dwelled on the following “talents”:

  • “pretty good at imitating pigeon sounds”
  • “can blow up 2 balloons at the same time using only my nostrils”
  • “I don’t have any real talents.” – at this point, our Dean turned toward us and said solemnly, “Now, that is just sad.”
  • “ear wiggling”

As if “ear wiggling” wasn’t unconventional enough, another student had listed:

  • “can wiggle both ears, flare both nostrils, and raise one eyebrow at the same time”

By this time, all of us were sobbing hysterically into our laps. I had a hard time believing that accepted medical students had had the nerve to mention their true “hobbies” in their med school applications.

As I sit here attempting to conjure up a deep, meaningful way to conclude this post, I ask my little sister, Nashat, for some insight. She says, “Medical school is for crazy people.”

Curiously enough, I’m convinced that she’s right.

 

P. S. For those of you concerned about the “church nightclub,” I found out from a reliable source that the nightclub was actually housed in a building that used to be a church.

 

 

 

Food

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First off, for those of you who just completed a month’s worth of 17-hour fasts:

Eid Mubarak

Happy Eid and Eid Mubarak! My sister and I went shopping for decadent delicacies yesterday:

Cookies and cream ice cream cake

Gelato

Gelato in sea salt caramel, caramel cookie crunch, and Caribbean coconut flavors – yuuuuum!

As I ate lunch for the first time in my medical school career, I reflected upon how Ramadan emphasizes quality over quantity. Within the past month, I lived through a cross-country move and the beginning of med school with only one meal a day, occasionally one and a half. Not surprisingly, my new classmates asked me if I missed having lunch or afternoon snacks. The answer was a definitive “no,” because the meals I did have in the evening tasted so much better! Ordinary dishes transformed into scrumptious feasts bursting with flavor – cheese sticks that melted in my mouth, spicy salmon with daal and rice, sweet yogurt lassi drinks, and freshly-baked pizza. Even after 7 consecutive evenings of cheese-stick dinners, the dish had not lost its novelty; on a non-Ramadan week, however, I would have had to employ copious volumes of awesomesauce to alleviate a severe case of tastebud-boredom.

Awesomesauce!

After a month of fasting, I not only appreciate food to a much greater extent, I also enjoy food  – it was no longer feels like a chore to complete before heading to bed.

I was also surprised to discover that fasting did not sap my energy throughout the day. I occasionally took breaks in between four-hour med school lectures to practice my karate move sequences on the back lawn – complete with jump-360s, tornado kicks, and spinning-hook-double-knifehand-block combinations. My sister and I even spent a Ramadan afternoon braving rollercoasters at Hersheypark.

Skyrush of Hersheypark – one of the most terrifying experiences of my life

Another concern allayed: I never once felt dehydrated while fasting. I was especially conscientious about my risk of dehydration and drank more than 2 liters of water a night. Last Tuesday, my blood pressure was a solid 120/80. Today at noon, however, my blood pressure was 105/70, which is lower than normal for my body. I also had cold symptoms that immediately subsided after I drank a 500 mL bottle of water; out of my post-Ramadan negligence, I had forgotten to drink water in the morning.

 

Do we truly need 3 meals a day to function at our full capacity, or do our meals serve more as comforting routines, or methods of procrastination? Food is a necessity, but perhaps not at the level I am used to…

The staple of my sister’s Ramadan diet. I tried to warn her about scurvy.

One thing is for sure – Ramadan is a month of fasting and feasting.

The feasts at Hogwarts School of Pre-Medicine. The College of Medicine desserts are better.

Farewell, Ramadan – until next year!

UPDATE 7/29/2014 I miss Ramadan. I miss being able to run out the door at 7:50 AM without wolfing down breakfast or packing lunch. I miss being able to walk home in the afternoon without an extra Tupperware container consuming space in my backpack.

Most of all, I miss the thrill of breaking my fast together with my family…

The View from My Bedroom Window

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From my bedroom window, I have a picturesque view of the pond and the weeping willows across the street at Hershey Lodge, one of the two premier resorts in the Hershey area. I like watching the occasional Geese Conferences, complete with squawking, waddling, and long swims under the gentle afternoon sun.

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If there is a more beautiful place to learn medicine… I haven’t seen it. And that’s a bold claim, because I’ve interviewed at sixteen different medical schools across the country over the past two years. For example, examine the following representation of student housing at one medical school I interviewed at last year:

In contrast, observe the breathtaking landscape of the Hershey Botanical Gardens in springtime:

Hershey, PA

Hershey, PA

The fact that I botched so many medical school applications no longer makes me cringe. I thank God every day that I’m in Hershey.

Teamwork Part 3: Reflections on Real-Life Emergencies

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Homaira’s Note: Please read “Teamwork Part 2” before starting on this post.

…and a gentle whooshing sound played from the lecture hall’s loudspeakers.

“The tsunami has hit the village,” Dr. Moser announced over the microphone. “You either survived… or you didn’t.”

And thus, the simulation came to an end. For the entire duration of the scenario, our team of 8 students had not moved from our desks, instead preferring to mime CPR movements from across the table and sort supplies by level of priority with a pen and paper.

After a short break, an emergency physician from our school spoke to our class about the implications of this scenario in true emergencies:

  • What it’s like to have your lead physician incapacitated during an emergency, precisely when you need her most
  • What it’s like to be forced to favor the lives of some of your colleagues over others – to send inexperienced personnel, such as medical students, downstairs into the path of danger while protecting more knowledgeable members of the team
  • What it’s like to be treating a patient in the ER, and to have to abandon the patient when faced with an active shooter
  • What it’s like to crash an Air Ambulance helicopter into the forest behind the hospital, and to have to run for your life, without the patient, because the helicopter might burn down at any moment
  • What it’s like to triage patients in an active shooter emergency – to favor the patient who is more likely to live, and to say to the 400-pound man, “Sorry, dude, but I can’t get you up the stairs in time.”
  • What it’s like to reflect back on an emergency – and come to the realization that you abandoned a patient who was indeed salvageable

Most importantly, we learned to value members of our team who we might have otherwise overlooked. The office assistant had no medical skills, but during the tsunami emergency, he served an integral role in communicating with patients. In fact, in the event of a real tsunami emergency, much of what is needed to be done could be accomplished by anybody, regardless of medical knowledge – fetching water and supplies, moving bedridden patients, etc.

Bottom line: Emergency Medicine is an intense profession.

 

Teamwork Part 2 – The Tsunami

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“You and your colleagues are currently on a medical missions trip along the coast of the Philippines. Your group consists of one attending physician, two nurses, three medical students, and one office assistant. 

For the past few days, torrents of rain have overwhelmed the village. You know from the radio that mudslides and floods have blocked all accessible roads to your makeshift hospital, which is situated on the first floor of an office building. The second and third floors of the building consist of offices and kitchens, while the fourth ‘floor’ is mainly filled with wiring and plumbing. There are thirty patients in the hospital at this time. Ten are ambulatory, and connected to IVs; fifteen are bedridden; and five are on ventilators. As it stands, the first floor is flooded with one-inch of water, and your group decides that it is time to move the patients and supplies to a higher floor.”

Our office assistant, who spoke Tagolog, instructed the ambulatory patients to take their blankets and bedsheets and walk up the steps to the second floor. The rest of us piled supplies onto the patient beds and wheeled the bedridden and ventilated patients into the elevators and onto the second floor.

On the radio, a siren blared.

“URGENT WARNING TO COASTAL AREAS. SEVERE FLOODING AND MUDSLIDES EXPECTED.”

“We already know that,” I told the other nurse.

I was trying to decide between salvaging the 80 bedsheets or the 40 blankets when the power went out. Without a moment of delay, the office assistant pulled out the Flashlight app on his iPhone.

“We can use the bedsheets as hobo sacks, or to help us rappel down windows if we need,” the office assistant suggested.

We all approved the novel idea – except for the attending physician, Grace. She was slumping in her seat with her face pressed against her desk.

“I don’t feel so well,” she mumbled.

We need to keep moving!” the office assistant bellowed over the din, scratching off boxes on his inventory of supplies. “Should we take the cell phone charger?”

“Nah,” one of the medical students said. “You probably won’t get reception in the middle of nowhere, anyway.”

“Don’t be so sure about that,” I said. “I’ve Skyped over a 3G connection in rural Bangladesh.”

A second medical student interrupted our discussion. “Guys! Grace is having chest pain!”

I called the other nurse and went to see the attending physician, whose face was contorted in pain as she whimpered and clutched her chest.

“I’ll administer nitroglycerin under her tongue!” the other nurse proclaimed, consulting the slip of paper in her hand.

“And I’m trained in EKG,” I said, consulting my own list of instructions. “But – oh no – chest pain – heart attack. Oh dear. Time for CPR!”

I called another medical student to assist me in treating Grace. Before I could start CPR, however, the siren blared once again.

“URGENT TSUNAMI WARNING. EVACUATE ALL COASTAL AREAS IMMEDIATELY.”

At that moment, my parched throat reminded me of the most essential necessity of earthly life.

Water!” I shrieked, leaving the medical student with Grace as I scrambled up the stairs to meet the rest of the group. “We have 80 one-gallon drums of water downstairs! You can survive without food for weeks, but only a couple of days without potable water!”

The office assistant marked “water” as “EH” (extra-high priority) on his inventory list.

When I returned to the first floor, Grace lifted her head from her desk and smiled weakly.

“She’s okay now!” the medical student exclaimed as I entered the room. “She’s even smiling! We cured her!”

As Grace limped toward the stairwell, the tsunami siren blared for the second time. I turned to the medical student.

“Why don’t we just leave the patients on the second floor and run up to the fourth floor before the tsunami hits?”

The medical student never had a chance to answer. We gazed up in horror through the screen above our heads. The tsunami loomed before us.

Whenever I had daydreamed of something dangerous happening in my life, something perilous and exciting, I had envisioned myself as the cool-headed hero, the one who swept up helpless children and grandmothers single-handedly and whisked them away from certain destruction. But now, our time had come to an end.

With nothing better to do, the medical student and I just stared.

To be continued in Teamwork Part 3

The Last Task: The Maze

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Original from July 22nd, 2014

Today, my Profession of Medicine professor, Dr. Haidet, emphasized the importance of maintaining our identity through four years of medical school. To jumpstart the discussion, he showed us a clip from Harry Potter and the Goblet of Fire, in which Professor Dumbledore warns Harry and the other 3 contestants about the treacherous task ahead.

Before Dr. Haidet began the clip, he instructed us to “pretend that the Maze is medical school, and that the Triwizard Cup is your M.D. degree.”

http://www.dailymotion.com/video/x1td817_entering-the-maze-from-harry-potter-and-the-goblet-of-fire-2005_shortfilms

People change in the maze. Oh, find the cup if you can. But be very wary; you could just lose yourselves along the way.

Upon finishing the clip, the entire class burst into hysterics. The eerie part was that Dr. Haidet was dead-serious.

In response to the clip, we were instructed to write about the perspectives we bring to medicine as unjaded first-year students, and who we envision ourselves as four years down the road. My response went something like this:

When I wrote my first personal statement two years ago, I was fully aware of the sheer magnitude of what I was trying to achieve, of how truly helpless I was as an individual attempting to alleviate human suffering in the face of ever-morphing government policies, the grisly side- effects of poverty, and the horrors that occur behind closed doors. In the past two years, my ideas have not grown any more bitter, but rather crisper and more subtle: akin to the flavor of fresh yogurt, as opposed to the oversweetened ice cream of my childhood dreams. Today, my memories are filled with the smiles of all the exemplary doctors I have worked with, who provided a listening ear for those who might have had no other source of nonjudgmental, sincere caring and advice.  Because of their guidance, I now know that it does not take a genius to a make a difference in a person’s life; a kind word might outshine any medication I could prescribe.

 As I progress through medical school with my colleagues, I will remember that every iota of our career is full of meaning, in unequivocal connection with the very purpose of our human existence – a gift that very few other professions have. When we feel overburdened by the incredible responsibilities of our lives – drug addicts and noncompliant patients, patients we cannot treat because of nonexistent health insurance, healthcare legislations that shift like custard pudding underneath our feet – I will remember that the worst day of my career will be more meaningful than the best day of many others’ careers. Regardless of the challenges we face on our path, this is the kind of physician I would like to become.

I may just follow through with Dr. Haidet’s advice, and keep a folded printout of this response in my white coat pocket so I won’t ever lose sight of what brought me to medicine…

Teamwork Part 1 – Einstein’s Riddle

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Original from July 21st, 2014

In order to demonstrate that teamwork is not a waste of time, nor a torture technique designed to hold back top students, Dr. Haidet presented the class of 150 medical students with the task of solving Einstein’s Riddle. According to Einstein, only 2% of the world’s population would be able to solve the puzzle.

When Dr. Haidet first saw the riddle 15 years ago, he spent 3 and a half hours arriving at his conclusion.

When our class divided into groups of 8, the first group solved the riddle from scratch in fifteen minutes. (Unfortunately, I was not a member of this group.)

I am so glad that Penn State College of Medicine emphasizes teamwork over competition – that also means Pass/No Pass classes for the first two years!

If you must satiate your curiosity, here is Einstein’s Riddle:

EINSTEIN’S RIDDLE

There are 5 houses that are each a different colour.

There is a person of a different nationality in each house.

The 5 owners drink a certain drink. They each smoke a certain brand of cigarettes and also have a certain pet. No owner has the same pet, smokes the same brand of cigarettes nor drinks the same drink.

The question is. “Who has the fish?

 

CLUES

1. The British man lives in the red house.

2. The Swedish man has a dog for a pet.

3. The Danish man drinks tea.

4. The green house is to the left of the white house.

5. The owner of the green house drinks coffee.

6. The person that smokes Pall Mall has a bird.

7. The owner of the yellow house smokes Dunhill.

8. The person that lives in the middle house drinks milk.

9. The Norwegian lives in the first house.

10. The person that smokes Blend, lives next to the one that has a cat.

11. The person that has a horse lives next to the one that smokes Dunhill.

12. The one that smokes Bluemaster drinks beer.

13. The German smokes Prince.

14. The Norwegian lives next to a blue house.

15. The person that smokes Blend, has a neighbour that drinks water.

 

If you give up, you can find a step-by-step solution here: http://udel.edu/~os/riddle-solution.html

Homaira

Professionalism

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Original from July 17th, 2014

On the second day of orientation, I was one of the last people to enter the lecture hall for an event entitled “Crash Course to Medical School.” The seats in the back rows had already been claimed, so I sidled past a pair of burly male students sitting by the aisle and settled into a seat in the middle of the second row. The seats to either side of me were empty, but one of the male students leaned over the vacant seat and introduced himself as “John.” He looked strangely familiar, although I was fairly sure I hadn’t met him in the past day and a half – I had probably seen him at Second Look Day.

Soon afterward, the Dean began his lecture on acting professionally, dressing for Grandma and not for the nightclub, and a myriad of other common-sense topics that everyone knew everything about anyway –

“So, instead of showing up to class in the morning looking as if you passed out at [the local bar] last night – ”

Out of my left ear, I heard a distinct series of clicks – “John” was increasing the volume on his Macbook to maximum levels. The next thing I knew, he pressed “play” on the YouTube music video and a deafening deluge of rock-and-roll flooded the lecture hall for the entirety of two seconds – the longest two seconds of my life. I shielded my face in my hands and waited for the disaster to end.

“Oh, sorry!” John smirked at the Dean as he stopped the video. The Dean’s smile became rather fixed.

As the incredulous rumbling in the rest of the lecture hall subsided, another male student in the back row was finishing off a call to his mom.

“Oh, oops, sorry Mom, I’m in class and I gotta go. Call you later!”

“Is there a problem back there?” The Dean addressed the back of the room, still smiling sweetly. Apparently there was no problem, because there was no answer.

The Dean resumed his lecture, only to be interrupted by the male student next to “John” who kept asking the Dean to repeat ordinary statements (“Sorry, could you repeat that?”) under the pretense of clarification. Then, “John” sighed loudly and lifted his feet onto the empty chair next to me.

Once again, the Dean paused his lecture mid-word. “Is there a problem here?”

“Oh, no, sorry.” John grinned widely at the Dean and lowered his feet back to the floor. “Just relaxing.”

Not another minute had passed before the next disruption took place. At this point, the Dean was attempting to focus the class on the importance of focusing in class, with limited success.

“It’s critical that you come to class alert and ready to learn – ”

Without warning, the Dean lowered his microphone and crept up to the third row on the right side of the lecture hall. In one of the aisle seats, a student was dozing with his navy blue hoodie drawn over the entirety of his head, which was planted firmly on the desk in front of him. The Dean tapped the student gently on the shoulder; the student met the Dean’s gaze with heavy, languid eyes.

“What class are we in right now?” The Dean spoke calmly into the microphone.

“Er… Crash Course to Medical School?” the student answered slowly.

“What were we just talking about?”

The student grunted his acknowledgment of ignorance.

“And what are you doing here, may I ask?”

“Crashing.”

A collective murmur rippled throughout the lecture hall.

“I think you and I will have a little chat after class,” the Dean finished, leaving the groggy student and returning to the podium.

He had barely begun the first syllable of his next bullet point when a pair of students in soccer jerseys and gym shorts lumbered through the front side entrance. One was dribbling a soccer ball, and they were both chattering loudly together until they saw the Dean. They immediately fell quiet – but instead of darting out the way they came, they walked behind the Dean and climbed up the aisle steps to the back-door exit as 151 pairs of eyes followed them in utmost silence.

The Dean attempted to continue as if nothing had happened, but he was interrupted once again by the loud crackling of a closet-sized bag of potato chips as a student in a middle row crumpled it in his hand. With a stoically fixed smile, the Dean bounded up the steps to meet the offending student.

“Is there a problem here?” the Dean asked.

“Yeah,” the student said, “at lunch they didn’t give us a big enough bag of potato chips, so I bought an extra large bag of potato chips for myself.”

“Would it be okay if I borrowed this?”

“I would prefer if you didn’t,” the student said.

Regardless, the Dean confiscated the student’s bag of potato chips. When he returned to the podium, however, he once again spotted a glaring violation of Professionalism. He climbed the steps to the third row and rapped Mr. Sleepyhead on the head with the bag of potato chips.

Wake UP!” For the first time, the Dean thundered into the microphone. Once the student jerked up from his slumber, the Dean asked him to leave the classroom. The majority of the class “oohed” in unison as the student swung his backpack over his shoulder and trudged through the front side entrance. The student sitting next to “John”, however, raised his hand.

“Sorry, could you repeat that?” the student said.

“I think you would like to have a little chat with me, too,” the Dean said, his dark eyes flashing dangerously through his smile. “Wouldn’t you?”

“No thanks,” the student said quickly.

At this point in my life, I deeply regretted taking my seat next to a couple of harebrained strangers in the second row.

The Dean finally progressed to the last slide of his presentation. As he was speaking, however, “John” switched on his rock-and-roll music at full blast. I dove my face into my sweat-drenched palms and peered through the miniscule gaps in between my fingers.

“Oh, oh – so sorry,” John said quickly as the Dean’s eyes gushed with saccharine poison.

To my chagrin, the Dean pointed straight toward me. The first thought that flitted through my mind was “I didn’t do it.”

“You – what’s your name?”

“Er…” I gulped down a ping-pong ball-sized globule of phlegm. “Homaira.”

“So, Homaira, how do you feel about what your neighbors have been doing in today’s class?”

“Um…”I paused as the class fell silent for my response. “I feel embarrassed.”

The entire class erupted in waves of boisterous laughter; even the Dean chuckled along with the students.

“Embarrassed! Okay, that’s honest. I like honest. But how did you feel that this affected the quality of your learning during this class?”

I answered with the best of what my mortified brain cells were capable of at that point – I weaseled my way out of thoughtful responses and then pretended to take notes when I was really writing “mortified” mindlessly throughout the blank lines on the open page. I tuned back into the lecture in time to hear the Dean say:

“I kept my cool because this was all set up. I would like to invite the second year students to come out of the audience and join us at the front for a Question and Answer session.”

The second years bowed to the audience, we applauded them for their extraordinary performance, and the rest of the afternoon was spent exchanging practical advice about the road ahead. Toward the end, the second years presented their own student-made Introduction to Medical School video for us to enjoy:

In summary, I was thoroughly fooled that afternoon. The disruptive students had not been first-years at all, but second year students who had opted to assist the Dean in illustrating some real-life concepts in the lecture hall.

Update 7/26/2014: I still find myself laughing about this impressive series of stunts whenever I happen to think about it. I am so grateful for Penn State.

A more serious moral of the story: we are no longer college kids. We are health professionals in training. Anything we do – how we behave, how we dress, and how we carry ourselves – will make an impression, for better or for worse, on our patients and the broader community as a whole.

 

 

 

 

 

 

The Sorting Ceremony

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“Well, if you’re sure… better be… RAVENCLAW!”

Yes, I am now officially a Ravenclaw – er… Waldhausen.

Sorting Hat Waldhausen Gif

At my medical school, all 150 members of the first-year class are sorted into four Societies: Bond (Gryffindor), Waldhausen (Ravenclaw), Vastyan (Hufflepuff), and Mortel (Slytherin), named in honor of famous  Penn State physicians in lieu of ancient witches and wizards. In my opinion, “Bond” and “Mortel” correspond with their Hogwarts counterparts perfectly. James Bond would have undoubtedly been sorted in accordance with the audacious legacy of Harry Potter’s own House, Gryffindor; and “Mortel” sounds similar to “mortal,” which describes The Dark Lord Voldemort’s ultimate fate pretty succinctly. As for the other two – I suppose Waldhausen fits with the “scholarly” Ravenclaw reputation because of the long German name, and Vastyan takes care of the “vast” leftovers who were sorted into Hufflepuff. (Needless to say, my Vastyan classmates aren’t too happy about the Hufflepuff references.)

The night before my first day of orientation, my sister and I began a solemn discussion about which Hogwarts House I was best suited for.

I said, “I’ll be a Hufflepuff, because I’m a duffer.”

Nashat said, “No, Homaira, you’re bookish. You have to be a Ravenclaw.”

The next day, what do you know…

Hogwarts College of Medicine

Over the lunch hour, Dr. W introduced me to my sorcery advisors. The portraits shown below were shamelessly Accio’ed from Dr. W’s PowerPoint presentation.

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Dr. W (Head of Ravenclaw House)

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Dr. K (The Dean, aka Headmaster of Hogwarts)

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Dr. M (Homaira’s Primary Advisor – Family Medicine, aka Care of Magical Humans)

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Dr. K (Homaira’s Secondary Advisor – Infectious Disease, aka Defense Against the Dark Ailments)

Now, actually recognizing my advisors face-to-face proved to be a challenge on par with navigating the Maze in the Triwizard Tournament.

The day ended with an inter-Society tournament of tug-of-war, run-and-don’t-drop-the-egg games, relay races, and popcorn-eating contests. Unfortunately, Ravenclaw won third place, behind Hufflepuff (first) and Slytherin (second), after a crushing tug-of-war defeat by Hufflepuff which left many of our palms raw and blistering. I am certain that the rope was weaved from the ascerbic tentacles of the Venomous Tentacula – there can be no other explanation.

Alas, the Hogwarts College of Medicine campus in Hershey, PA features no Great Hall for majestic dinners under the virtual stars… but we do have a Great White Tent, underneath which we shared tacos with our Societymates. I was fasting that day until 8:30 pm, so I opted for the Invisible variety of taco filling before walking 15 minutes home to my apartment.

That evening, I watched the palette of sunset blend with the weeping willows in the pond across from my apartment. Of all the medical schools I could be attending, I am thrilled to be attending Hogwarts College of Medicine – Hershey Campus.

Homaira’s Note: I hope to deemphasize my Hogwarts references in my future posts. However, seeing as that Dr. W borrows heavily from the Harry Potter universe in his Society communications, that may prove to be a challenge…