Tuesday, July 16, 2013

Heart Attacks

It was really hard to wake up this morning, I had to really drag myself out of bed. I have never run into shower traffic before and because I woke up not so early today I had to face it. While waiting for my turn I realized that these two showers are being shared by about twenty girls. Not to offense anyone but whoever designed the building really needed to re-evaluate themselves. It is pretty risky to ask twenty 16 years old girls to share a small bathroom unless this is some sort of prepare-for-life test. 

Today for class half of us had a clinical experience while the other half stayed to watch some medical show. We watched "Grey's Anatomy", "Scrubs", and "Private Practice". While watching we were asked to write down what we think is realistic or unrealistic about the shows and anything interesting that we would like to discuss about later. This was my first time watching these shows so I was not sure what to expect. After the first five minutes of watching I got a clear message that the professional and personal lines in these shows are not parallel whatsoever. I wrote that down as unrealistic because I know in most places its frowned upon to have a relationship with your co-workers. I also notice how everything worked at a more nonchalant but fast pace in the show. For example, it would take a few minutes for a virus to spread while in reality it may take weeks and the doctors in the show only see one or two patients while real life doctors see over 30 a day. I learned a really important lesson from Grey's Anatomy. All doctors should go all the way, even if their patient's heart stop beating, so that they can truly tell the family that they have done everything they could. The show also portrait some hospital related ethical issues such as whether or not a man who cause another man's death by accident and beats his wife should get a liver donation. If I was a doctor my primary role is to tend to the well being of my patient and if that man was my patient then it's my obligation to treat him any way I can. Personally, as cruel as it sounds, I would have given him the liver. 

Our after lunch class was a team based learning class. TBL includes three phases: Pre-reading, readiness assessment tests (individual and group), and application. We were given an article the day before to read. The article was about coronary heart disease and the treatments. It was also about how to detect heart attacks and specifically what drugs can be used to treat it or prevent it. The words used in the paper just made my brain melt. It was one of the most difficult paper I have ever read! I had to read it three times before I could even understand it properly but I didn't mind because I love a good brain challenge.. Then in class were were given the I.R.A.T (Individual Readiness Assessment Test). As soon as my eye laid on the first question I could feel my brain dying but I carried on. After the IRAT we had the same test but together with our group. Each instructor had a group and I was a part of Team Jake. For the group test we used these special scratch card that would let us know if we got the question right or wrong. Our group ended up scoring a 70% on the test which ,according to Jon, was way higher than what he expected. I was really proud of us and myself. I got a 70% as well on my own test. When we had to justified our answer, it turned out that we had the same way of explaining our answers as Jake. He taught us well. Before moving on to the application process of TBL Jon told us that the article was something a real life medical student would have to read and that blew my mind. The awesomeness of this class just keeps on rising at a quick pace. 

So for the application process we were given a case and we had to decide what to do. So our "patient" is a Ms. Daniels who is 54 years old and she has several risk factors (obese, smoker, diabetic, physical inactivity, high BP and HR) for coronary artery disease. She went to the emergency department complaining of angina (chest pain) and she gets them whenever she exerts herself. This actually went a lot rougher than the GRAT because we all argued about how to treat Ms. Daniels. We decided on testing her for troponins ( an enzyme presents when there is necrosis) to see if she is having a heart attack. Then we had her find a primary care physician and have her take 81mg of aspirin daily. Then the second part of our case is when Ms. Daniels came in again after 30 minutes of 10/10 angina (on a pain chart) and her troponins levels are at 2.5 (normal is < 0.01). We had to decide if we should tell her that she is having a heart attack or run more test to be sure. I was sure that she was having a heart attack and I fought for it. We were all yelling and arguing about the case and it was complete chaos. Our instructors were enjoying every minute of it. I knew because it usually takes about 3-12 hours before troponins are detected accurately and it has only been 30 minutes for Ms. D and her level are off the chart. Some students wanted to do more test to make sure but the best test was to check the troponins level. When someone is having a heart attack there is a golden hour that you have to work in to increase survival rate and test would have wasted time. Jake told us that we were like real doctors arguing over a patient's treatment except there is less yelling in real life. In the end about half of the class along with me were right, it was a heart attack. 

The case was far from over because then we had to deal with some ethical issues. Ms. D could not afford the treatment but she needs it to save her life. I chose to persist on giving her the treatment and have someone take care of the financial issue after. Jon said that as a doctor, my job is to care about the health of my patient and that's it. It would have been unethical for me to get involved with Ms. D's financial problems no matter how right or wrong it is. I agreed while some of my classmates did not. They thought that they should have called the billing department and work out a plan before giving the treatment to Ms. D. I want to be a doctor to save lives and help people and I would rather not take my focus away from caring for the health of the people. It would have been more wrong and even illegal to turn people away because of their financial status. 

After class I had my self defense Arete class. Today we practiced more on how to get out of a hold and then we learned about how to evade attacks and how to escape a choke hold. Instead of dinner today we had a proctor night. The night before we sang a song and asked out another girl proctor group and today we are going to a fancy dinner with them.

Toby, Savannah, Maggie, me, and Carolyn
We all put on our fancy dresses and headed toward Cabana. I loved how instead of having bread they got their southernness on and served biscuit. I ordered a grilled steak with asparagus and mashed potato. The dish looked good and it tasted even better. The steak was grilled exactly how I like it, pink but cooked. It was so perfect and delectable. When we were done with Cabana, we went back to the dorm house and baked cookies and watched a movie.

My day has been so wonderfully awesome, from class all the way down to bedtime. However after two days of sore throat and friendly (or not) yelling, I am starting to lose my voice. Everyday at VSA just gets better and better and I can feel my brain doing the happy dance everyday from all the knowledge it is soaking in. 

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