Town Doctor

David Steinhardt, MS4

eastern-oregonThe road to the town where I did my rural clerkship travels east from Portland until you reach a sharp turn off Highway 84 that heads south. Soon after leaving the highway, you lose cellphone service and have to brave the rest of the route on your own. The hills are vast, beautiful, and seemingly endless, covered in green and yellow-shaded grass with scattered trees and occasional ponds sparkling in the sunlight. Compared to Portland, it feels like another planet, with wide-open space in every direction and far more cows than people. The town’s welcome sign sits in front of two large historic tractors, signaling arrival to a town that prides itself on working in the fields – growing wheat and raising cattle.

On the first morning of my rural clerkship, I felt like I had traveled back in time. The hospital was a single-hallway building consisting of an Emergency Department, ten hospital beds, and a nursing home facility all under one roof. The clinic was just up the road, allowing the doctors and staff to cover the ED, inpatient service, and clinic all at the same time. Immediately, I was struck by the friendliness of the nurses and the rest of the staff – the visiting medical student (me) was a familiar tradition, transitioning every 5 weeks from one of us to another, but they didn’t seem to mind the consistently rotating wheel of new faces.

That first morning, I rounded on an elderly gentleman who had suffered a devastating stroke two days prior, but had been started on steroid medication and his mental status was beginning to improve. We talked for a while that morning, and I learned that he was on hospice care, likely destined to spend the rest of his life in this small rural hospital. We parted ways that morning, and at that point he was simply a patient, similar to the patients I had met and treated at OHSU.

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Tomorrow’s lessons

Anushka-Shenoy-banner

Dear ——–,

You were my patient for four days. On the first day, we treated your many diseases. On the second day, we removed all but comfort measures. When I arrive at the hospital tomorrow, you will not be there. My boyfriend worries about me tonight, as you are my first patient to die. I am surprised to tell him that I feel only gratitude for you.

Thank you for being my first patient to die. Thank you for being old and frail. Thank you for displaying clearly and eloquently, despite an illness that has robbed you of speech, your desire to move on.  Thank you for smiling at me on day one, for asking my name, introducing yourself. Thank you for clutching my hand on days two, three and four when I came to wet your lips and ask you if you were in pain. Thank you for not being in too much pain. Thank you for having a caring family who loves you but does not depend upon you, who will have each other to share memories and grief on days five, six, seven.

I am so sad that you will die tonight. I am sad for your children, who have hovered around you over the past four days, and for your spouse, whom you cared for with love and kindness. I am so sad that we don’t get to unpack your ailments together, one by one, stating them in a problem list and labeling them – acute, worsening, improving, resolved. I don’t know how to write a discharge summary for you. I can’t discharge you from my mind: your kind eyes, your thin, frail skin, your erratic, persistent breath, your fervent dignity in the face of your body’s determined deterioration. Thank you for sharing this part of your life with me. Thank you for sharing your death with me. Thank you for your teachings over the past four days and for the lessons that await me tomorrow.  Thank you.

The Trouble With Girls and Women Scientists and Why We Won’t Just Stick to Shoe Shopping

Let’s be clear—the word “woman” is a noun. It is not an adjective.

And yet the inclusion of the word “woman” as an adjective, to subtly yet profoundly undermine the notion that women are capable, is everywhere. This prefix is not accidental, it’s diminutive, an inherent nod to the notion that women are somehow out of place in the sciences. The word “woman” as an adjective is used to suggest that there’s some kind of novelty to a female working as a professional scientist;  “Look at this woman scientist—she’s even wearing a lab coat! Isn’t she trying her best? Adorable!”

Take, for example, the comments made recently by Nobel laureate Tim Hunt. At the World Conference of Science Journalists in Seoul, South Korea, Hunt described the trouble with girls: “Let me tell you about my trouble with girls … three things happen when they are in the lab … You fall in love with them, they fall in love with you and when you criticize them, they cry” (You can read more about his comments at The Guardian).

I’ll be honest you guys….I’ve cried in lab. A little saline never hurt a tissue sample, right? I just don’t understand how a NOBEL LAUREATE could think that the experiences he’s had with a few women in his laboratory could ever possibly be extrapolated and applied to ALL women?

In 2013 Fang, Bennet, and Cassadevall published a study in which they analyzed the 228 instances of scientific misconduct reported to the Office of Research Integrity and found that over two thirds of the cases involving fraud were committed by men, a number that “exceeds the overall proportion of males among life science trainees and faculty.” But who is talking about that? Where is the female Nobel Laureate condemning men at scientific conferences, decrying their role in labs; “Good point, Hunt, you really got me there. I was just about to kiss you and cry, but I thought I’d make this counterpoint first; the trouble with boys in lab is that they lie and make up data and ruin their careers and yours in the process. I’d love to hire more men, but you just can’t trust ’em. Plus they’re so tantalizing. Does anyone have brownies?”

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A Plan with Not Quite Enough Time

Lumbad-student-speak-banner“Patient is a 26 y/o otherwise healthy, devastatingly handsome male with a history of PSVT. He presents to the ED with three ex-EMS personnel all equipped in softball attire. Patient states that he’s had 4-5 episodes of heart palpitations for the past hour. He’s attempted valsalva maneuvers with some success, but cannot ‘get out of this one.’ Patient reports lightheadedness and tunnel vision. He relates paresthesias and hypothermia of all four extremities and says ‘walking feels like there’s cement in my shoes.’ He denies chest pain but confirms precordial numbness. On physical exam he’s alert, oriented, and does not display any speech deficits. He’s hypotensive at 88/46 right arm supine and O2 sat at 93%. A 12-lead ECG reveals a regular, narrow complex tachycardia at 180 bpm without visible p-waves. ECG is negative for T-wave inversion, ST elevation and Q-waves. Delta waves also absent…”

In light of my recent trip to the ED, I was reminded exactly how impressed I should be with the human heart. In my chest there it is lubbing and dubbing – autonomically, instinctively, protectively. Normally, I don’t have to tell it when or how hard to beat. But rather, it tells me two things: 1) “you’re alive” and 2) “dude, you’re out of shape” when I take the stairs from the first to fifth floor in the CLSB. When we moved into this spaceship of a building last June, I would have been completely lost in the medical jargon the ER attending and resident were throwing around me during my ED visit. Now, my classmates and I are running the final lap of the didactic 4-minute mile with just over a week to go. We’ve covered the human body from head-to-toe, from preconception to old age and back over again. We ran ACLS megacodes for when a patient’s life is at stake, and this week we focus on how to intervene and prolong life in the O.R. The amount of information that has been crammed into our brains and regurgitated to our professors, clinician mentors and patients is mind-numbing and down right impressive.

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Veterans Affairs Nursing Academic Partnership (VANAP)

StudentSpeak is pleased to present this guest post by Jason Warren. Jason is a Senior Nursing student at OHSU and Student Nurse Technician (SNT) at the VA Portland Health Care System. Jason will be spending his senior year at the Portland VA ICU for his Integrative Practicum. In his free time, he enjoys rock climbing and bouldering, disc golf, and playing guitar.

 

Prior to starting my first term of nursing school at OHSU, I had the opportunity along with sixteen other students to join a new program focused on preparing future nurses to care for the complex needs of our veterans. Students do not have to be a veteran or have any connection to the military to be a part of this program, just the desire to work with veterans. However, the Veteran Affairs Nursing Academic Partnership (VANAP) appealed to me because I have veteran family members and a family member in active duty.

Almost two years after I signed up for VANAP, I can say that the experience has been truly amazing. My clinical experience has been nothing but positive. I have had the privileged to learn from RNs at the Portland VA on 8D (Acute 1 & 2), the Vancouver VA’s Community Living Center (Chronic 1 & 2), and most recently the Veteran’s Recovery House (a residential rehabilitation treatment program for alcohol and substance abuse) in Vancouver, WA.

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The Best is Yet to Come, Part II: Reflections on Graduate School

StudentSpeak is pleased to share this guest post from Kelly Chacón, who graduates June 5 with her doctorate in Biochemistry and Molecular Biology.

For Part I of Kelly’s post, click here.

Finally my fifth year arrived. I was ready to finish, even if I wasn’t actually ready to finish. My third paper was published, which is the deal we make for graduation in my lab. And I was accepted to give a little “data blitz” at my sub-field’s main scientific conference. A key professor saw me give that 5-minute, ridiculous presentation (I’m sure 3MT’ers can relate), and invited me to give a real talk at another conference. That was terrifying, and awesome, and I accidentally switched the U and the L in the word “results” on my slide.

I’ll let you spell that out.

I only mention those talks because they led to something unexpected. At that conference, I invited a professor to give a joint seminar for OHSU and Portland State (my alma mater). While having a beer with the speaker after their seminar, a friend alerted me to an open assistant professor position in chemistry at Reed College, here in Portland. Reed?! That’s my dream job! But I’m sure it’s too soon. Nevertheless, I decided to send in an agonized-over cover letter, if only to develop some resilience to being rejected. It turned out that Reed and I were actually soul mates. After three months and a long interview process, I was offered the job! And all because of a 5-minute data blitz.

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The Best is Yet to Come: Reflections on Graduate School

StudentSpeak is pleased to share this guest post from Kelly Chacón, who graduates June 5 with her doctorate in Biochemistry and Molecular Biology.

Sometimes I like to tell people that graduate school is a lot like marriage, but to a place and people that you love, but aren’t, like, in love with.

This feeling about grad school has only sharpened now that I am a newly-minted Ph.D. (well, so long as I get my butt in gear and incorporate the pile of edits my thesis committee has requested). Anyway, I find myself waxing nostalgic about my experiences of the past five years…to a point. So here, in these two posts, I will try to summarize the insanity of my time as doctoral candidate as well as some of the highlights along the way. Brace yourselves, because it will be a lot like an episode of M*A*S*H* – one part maudlin, and one part irreverent…and completely fueled by gin.*

Let’s see…years one and two: Instantaneously gaining 10 pounds (still with me three years later), overwhelming imposter syndrome, fleeting – false – moments of feeling smart, and overall indignation at the way I had only gone from being an “undergraduate baby” in the eyes of the world to “graduate baby.” Arrrrgh I’m 29 years old for crying out loud, I’m not a baby anymore! JUST FORGET IT I’LL BE IN MY ROOM WITH MY SMITHS ALBUMS, OK?!

Good times! No, but seriously – at least I was in grad school, actually getting paid to do science in a nice university and with a pretty cool mentor, too.

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The patching of a bleeding heart

The following has been selectively fictionalized to protect the identities of those involved and events that occurred. Names, races, ages, times, conditions, details and more have been modified or excluded. Originally published on The Biopsy.

“I just need a refill.” Kevin muttered under his breath, rocking ever so slightly in his chair, his grip fidgeting on the handle of his cane. The crease in his brow, bent from months of constant worry, shifted as the interview went on. One could tell he worked with his hands; the creases in his palms and fingers burrowed deep next to his weathered callouses.

Kevin’s file was littered with a litany of problems that painted a clinical picture — similar to what I see on exams every few weeks — and my mind began imagining him in archetypes. Medical students are trained to become expert pattern recognizers. In the pre-clinical years of medical school, those patterns are layered into the phrases and buzzwords of multiple choice tests. Child with flank pain? Wilm’s tumor. Blood in urine? Nephritic spectrum disease. Sudden dizziness upon standing? Look for Prazosin. The real world, however, is different.

Anxiety was listed among his many diagnoses. That’s probably why he was here; he needed a refill on his medication. If I were his provider, this visit would have been short, but I’m a medical student. There’s a structure I need to follow, details I need to elicit, a report I need to present so that the attending physician may make the best decisions for the patient’s care.

I scribbled on my notepad, Kevin, 35 M. Rx refill…

Nepal

MSF, Indonesia 2004

Santhosh, Nepal 2015

I’m behind on several papers, some stats homework and the apartment could use a little picking up. All that’s been the normal state of affairs for the past year. What has caught me a little off guard over the past couple of days is my distraction with the earthquakes in Nepal. In addition to the photos from the news media, I am also getting some photos from Santhosh, a kind orthopedic surgeon who I worked with post earthquake in 2004 in central Java with Médecins Sans Frontières (Doctors without Borders). It’s difficult not to be concerned about the safety of the aid workers who have responded to this disaster; especially when you haven’t heard from them in a couple of days. From past experience you realize that nearly every waking hour is focused on patient care and safety and there is little time and few internet opportunities to leave messages to friends.

So here’s hoping for the safety of all who have responded to the earthquake in Nepal!

Only Three Minutes

Let’s pretend you’ve signed up for the Three Minute Thesis.

What that means is you’ve got three minutes to explain your thesis—both the results and significance of your project—to a non-scientific audience.

Why did you do it? First, it’s good public speaking practice. Second, it’s a great opportunity to express your creativity. While you know that science is wonderfully, elegantly creative, it’s hard to convey that creativity to people outside of science. The crux of your research project is buried under six feet of complex jargon.

Even the simple things take lots of description. Although you’ve explained it a dozen times at the dinner table, whenever your parents hear the phrase “Western blot,” they can’t help but imagine a Rorschach test in a cowboy hat.

For the Three Minute Thesis (3MT), you’ve got to think outside the box.

Now that you’ve chained yourself to this radiator of an event, you’ve got to think of an idea. How are you going to present your research?

You should wrap your presentation in a metaphor, you think. Have an overall theme and a metaphor compelling enough to capture attention, but simple enough to be immediately understood.

You sit at your desk, dramatically crack your fingers and hunker down in front of your computer to compose the Next Great American Presentation. What’s the main underlying theme behind your project? What’s the important take-home message?

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StudentSpeak

StudentSpeak

Ever wondered what life is like as a student at OHSU? What does it take to become a researcher? Just how gross is gross anatomy? Welcome to the blog that answers these – and many other – questions. It’s students writing first-hand about their commitment to careers in science and health care. It’s honest about the challenges as well as the joys. It’s not always pretty. But it is our story. Thank you for sharing it with us. And please, let us know what you think.

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