Wednesday, July 17, 2013

Admission Officers Are Super Humans

Amazingly I woke up before 7 AM, with help, and went to the gym. It actually felt really nice to breathe in some early Nashville air. When I returned to the dorms, I ran into shower traffics again. I ended up being late for breakfast and had to rush my eating a bit in order to get to class on time.

We started class with a short video about doctors making mistakes. The doctor speaking in the video is actually a very experienced doctor and his name is Dr. Brian Goldman. He spoke about his first mistakes and how much he beat himself up for it. He had treated an old lady while he was still doing his residency and he did not confirm his actions with his attending. The old lady had to come back to the emergency room after collapsing in her home. It was the first time he heard the three dreaded words, "Do you remember?". He was then told that the old lady had to come back because she had brain damage. Unfortunately she passed away the following week. Dr. Goldman really beat himself up and he worked himself harder to improve and be a better doctor. However, he made many more mistakes after the first one and he talked about the horrible shame and gut wrenching guilt. After watching the video, we split into our group and had a short discussion about what we saw. I know it is inevitable but I hope that I never have to make a mistake that would cost a life.

We also talked about this article we had previously read about another doctor who made a mistake and a baby died in the process. Jake told us that when dealing with situations where you have to tell a deceased patient's loved one about your mistake it is best to stay strong and not cry. Apparently there are people who conduct studies about dealing with these kinds of situations. Then we talked a little about hospital lawsuits and how to decrease the chance of a patient suing you. 

After the discussion we had a guest speaker named Dr. Douglas Heimburger. He specializes in internal medicine with a sub specialty in nutrition and he does a lot of global health research. Dr. Douglas came in to talk to us about how nutrition can affect HIV/AIDS treatment. He conducts his studies in Zambia, Africa where there is a large population of HIV victims. His patients are usually those who had a BMI of less than 18. Most patients who are in this condition would pass away after 90 days of starting antiretrovirals while those who go through nutrition rehabilitation would have a survival rate of about 80%. When you have HIV/AIDS, death is inevitable but if you respond well to ART then you can live longer and your chance of transmitting the virus to someone else is significantly lowered. I thought that this lecture was really interesting because it gave me a whole new point of view.

During my last summer, I did a project on HIV/AIDS and it was based on the Granich paper from the Lancet. My project focused more on mathematical models to calculate the mortality of HIV victims if they were to start ART the minute they are tested positive. The usual thing is that you would start the treatments after your viral load gets really high but the Granich paper suggests that if they start the treatment after being tested then they would survive better which will result in a higher chance of getting rid of HIV.

While Dr. Heimburger based his studies on real trials, the Granich paper used mathematical equations to simulate real life situations and factor it to calculate the mortality rate and the prevalence of starting the drugs early versus after it gets severe. However the method Dr. Heimburger used is more practical while the Granich method is expensive and it raises ethical issues. While the topic is a bit sad it was really exciting to be able to be exposed to a whole new world. 

Before class ended we had a practice history taking and physical exam session. Jake, also known as best instructor, acted as our patient. We each got to ask him a question about his 'pain' and his medical history. Then after we got a pretty detailed history of his current condition we started some diagnoses. We went through the physical example process without actually giving one and we got Jake's vital signs from Jon. After a while we successfully diagnosed Jake with appendicitis. If we actually added the physical exam, the process was pretty long and I really admired doctors for being able to remember it all.

The after lunch class today included a lot of lecturers. First was Dr. John Nadeau who taught us about hypertension or more commonly known as high blood pressure. If your blood pressure is around 120/80 then that is normal but if it's between that and 140/90 then you are pre-hypertensive. Any higher than that you would have to start getting treatments. High blood pressure increases your risk of getting so many other health problems it's not even funny so it's best to treat it before it goes crazy.

After the hypertension lesson, we went to the lab across the hall to meet another lecturer. Dr. James Atkinson is a pathologist, meaning he studies diseases. He brought with him several hearts of patients who have donated their organs to science. I was way over the moon when I found out we were going to see some real hearts. Dr. Atkinson started off by showing us a normal sized and healthy heart. Then he showed us a heart of a patient who had necrosis (dead tissues) and survived via heart transplant. As he showed the heart and told us about it he passed it around for us to get a closer look. He also showed us the heart of a patient whose dead tissue had been replaced by scar tissues which had been hardened. There was a heart of a man who had heart failure and his heart was about the size of a small person's head. The heart was big because after years of blood not being pumped out of the heart correctly it grew. It is not good to physically have a big heart. He showed us another heart that had two artificial heart valves in it because the patient's original valves had been calcified. Then Dr. Atkinson showed us some aorta and one of them had an aneurysm in it. Everything was just so cool and I couldn't believe that I got to do all that.

Last but not least was Dr. William Barrow, who lectured about strokes. I learned so much about strokes that I didn't already know. Strokes can occur anywhere but it ends with the brain not getting oxygen. Anything that happens to blood vessels that can cause it to stop delivering blood properly can cause a stroke. Strokes can take away your abilities to do things that you would normally do. For example, strokes can cause you to not be able to control your arm and you won't be able to play a sport you love. Dr. Barrow mentioned cases where the stroke hits the part of the brain that causes the patient to tell pun non-stop orthe complete opposite, lose their sense of humor. Strokes can happen to everyone and anyone and it is completely unpredictable. But if you keep a healthy lifestyle then your risk factors are lower.

We had dinner at the Dean's house tonight so we could meet admissions officers and learn about getting into college. After having a small feast in his backyard we all headed to the Rotunda to start the meeting. To help us learn more about the admissions process, the officers had us take their role. They gave us the real applications of four students, from several years ago, and asked us to admit one, deny one and put two on the wait list. We all got together in different groups with two officers each to make our decision. We had to look at the application wholistically and decide who was better qualified. We had to look at the goods of the student and why they should be admitted. Just deciding between four students was difficult and I just had to compliment all the officers with their amazing ability to read hundreds of applications and make decisions. I also learned that I am really pessimistic because I keep getting the urge to point out the flaws. It was really an eye opening experience to be able to stand in the shoes of an admissions officers for a brief moment. I got to see how they evaluate everything as a whole and they do not compare students.

I ended my night with another monopoly game with my friends. Sadly we did not get to play for long but I had lots of fun. I learned so much today and my brain is just so happy. I have no doubt that tomorrow would be better because at VAS everyday is better than the last.

1 comment:

  1. Wait until some of those admissions officers start rejecting you or your friends and see if you still think of them as super human or sub human. ☺

    Like you, I don’t envy them their job. It’s especially difficult when you consider how little time they’re allotted to each application. How can your whole life and your whole being be summed up in just 15-20 minutes?

    As for the doctor who spoke of his failures, deep down inside we know that doctors are just as human as the rest of us which means that mistakes will be made. Old folks like us grew up with Dr. Kildare, Ben Casey and Marcus Welby—who never made a single mistake in their entire lives—but today we have House who damn near kills his patients a half dozen times before miraculously saving them at the last second.