Thursday, March 31, 2011

Anatomy 101: How I survived

There is no two ways about it, Gross Anatomy is the single most time consuming and challenging class you will ever find yourself facing. Unless of course you are an anatomy guru in which case it comes easy for you, but myself....I am no anatomy guru. I had to work, hard, and keep working to get very point to achieve the milestone of passing gross anatomy.

1. get a atlas....or two :)
I had a previous edition of Netter's lying around, plus I picked up a Rohen's and a Thieme.
I found I did not use the Netter's as much. I liked the Thieme over the Netters due to the fact that the Thieme has charts in it which helped me to organize and condense information about origin, action and insertion. I also liked the more stylized drawings than the hand drawing style of Netters. But this is entirely a matter of personal preference. What I would recommend is going to your school's library and looking at both of these atlases and determining which style you like best and will work best for your learning style.
I could not have survived however without my Rohen's. I used this to study the cadaver look at home when I could not physically be in lab. I feel like when I did this before we dissected I had a better idea of what to look for in the lab. Plus, I found that most tagged examples for practicals were based on the best cadaver example in class so looking at an idealized picture of a cadaver with how it would appear was exceedingly helpful.

2. the textbook to end all textbooks: grays anatomy for students
I tried the text recommended by our school which was essential clinical anatomy and I personally did not like it. It was too brief and I found the text to be very choppy. I did not use it much for my first exam and while I did well I felt like there was a lack of understanding on my part that I could not quite explain. So I researched on amazon and saw the great reviews of gray's anatomy for students and decided to try this book for my future studies. I used this book for the last three units of anatomy and really felt that the way it was laid out and the order of the text correlated well with my notes. I felt like when I used this text in conjunction with the notes that I gained a better understanding of the material and it eeked over into lab as well.

3. study for class and lab together, do not treat them as separate entities.
I made this mistake for the first exam. I tried to treat the written class portion and the practical lab portion as two separate yet equal entities. For all subsequent unit exams, I would study my lecture notes with an atlas open and my text open and integrate what I was reading into what I would see in the lab. Anatomy is such a highly visual subject and I am a highly visual learner so this worked really well for me. Again, what works for any person is highly personal and you will have to figure out what works best for you but I do recommend integrating the two portions of the class as it helps in both areas to make studying a little better.

4. time in teh lab, time in the laba nd time in the lab
there is no two ways about it, you need to spend a significant part of your time outside of class in the lab looking at cadavers. I personally was fond of Saturday mornings as I found that I was often by myself or with a few other people. I never found it helpful to be in groups as I needed to work through the material at my own pace with my own methodology.

I know these are all what worked best for me, so take what you feel you can use and eliminate what maynot work. But this is how I survived anatomy :)

Wednesday, March 30, 2011

The family crisis: My granny and her miracle

As many of my fellow nontraditional students are probably know, when we were younger daycare was not as commonplace and if there was one it was very expensive. Both of my parents worked, so I spent the majority of my childhood with my two grandmothers.
My life became less full when I lost my paternal grandmother to lung cancer in 1998.
My life almost came to a freezing halt this past November when my maternal grandmother ("granny"), the only grandparent I have left, told the family she had been having vaginal bleeding for sometime. Now for a woman in her early 80's, this is not a good thing, especially given the fact that she is on blood thinners for her atrial fibrillation. There have been various points in this whole ordeal when I have thought about taking a leave of absence and coming back next year and doing it all over again, but each time i even think about it I know how upset my granny would be because she knows how hard I worked to get here and the sacrifices I have made and she wants me to continue. Anyway, so after granny saw various specialists, they determined that the only thing they knew was that her lining of her uterus was thicker and they wanted to perform a D&C to see if that ended up halting the bleeding. January came and the D&C was scheduled. The doctor began doing the D&C, but stopped when he saw her cervix as he felt that something did not look right and he was very concerned about cervical cancer. This absolutely terrified me.....I do not know of anyone who ever likes to hear the "c" word but in this case it is particularly terrifying. You see, a few years ago my granny was diagnosed with Chronic Lymphatic Leukemia (CLL) and she has been doing remarkably well, her white blood cell count has stayed under control and has not spiked as they were expecting it to after she was first diagnosed. So the prospect of cervical cancer, and of any treatment that may accompany it, was particularly scary. As it would turn out, this doctor by stopping the D&C and not continuing, most likely saved my granny's life. So when they stopped, they took a small biopsy to see if their suspicions were correct and they wanted to schedule her for a hysterectomy. So, one was scheduled for two weeks later. The biopsy came back shortly before they did the hysterectomy, and all it showed was blood and inflammatory cells but no cancerous cells, the gynecologic oncologist said he could not rule out cancer because of the fact that you would expect to see inflammatory cells in a cancerous area.
The day of the hysterectomy came. Since they suspected cervical cancer, there was a high desire to keep everything well contained and limit the possibility for spreading, leading to the decision to make the operation open vs laproscopic. Once they began the operation, the surgeons encountered a more difficult situation than they had imagined. A few years back, my granny was also diagnosed with diverticulitis but no one really knew how bad it was. Apparently it was worse than any of us could have ever possibly imagined. Granny had extensive scar tissue and adhesions in her pelvis as a result of the diverticulitis which made the removal of the uterus without damaging the colon a very tedious procedure. Afterward, the doctor said he was worried about the possibility of a colon perforation as diverticulitis weakens the wall of the colon and in the process of removing the adhesions/scar tissue they were worried that the wall would not be able to withstand the stress. So as a precaution, they kept her in the ICU over the weekend.
Even though she was running a fever, it broke and she was transferred to a regular bed on Monday. But Tuesday she began running a fever again and her chest x-ray showed she had pneumonia. Then Wednesday she was still running a fever but was very weak, barely keeping her eyes open and was in severe abdominal pain.
then Thursday morning, the Thursday before finals week, I get the call I have been dreading for the past week. My granny;s colon has perforated and they will be performing an emergency surgery to repair the damage later that day. I picked up all the kids and we went to the hospital to wait with everyone for word. The surgery took over 5 hours. There was also an abscess in the upper portion of her abdomen and one of her ureters was damaged, so all these things need to be fixed leading to a quite extensive surgery. Every person in that waiting room knew the moment we saw the surgeon that the news was not going to be good. He told us that my granny was in septic shock from the colon rupture and she was in acute renal failure and that she may not survive the weekend. My granny was back in the ICU, sedated and paralyzed and on a vent. Somehow, even though finals had started and I had one the next morning, I managed to hold things together. I still do not know how, I chalk it up to perhaps being in shock...of not really believing what I was hearing of not realizing the extent of what was ahead of me.
Then the next morning, I took my ICM exam and the weight of the previous night hit me like a ton of bricks. It was Friday...and Monday held the exam that stood between me and passing Anatomy. And I hit full freak out mode. Worse case scenarios started running through my head. Something happening over the weekend, me taking the time to spend with my family and not devoting the time to anatomy, and then as a result not being able to achieve the needed points to pass.
This is one of those cases where I was reminded again how lucky I am to be where I am and how incredibly supportive the university is of students.
I went and talked to one of our associate deans and she officially let me freak out, which I think at that point in time I needed to do. She reminded me of all the hard work I had put in to be here and she asked me what would my granny want me to do? Would she want me to risk all of that hard work and sacrifice for her or would she want me to try to continue on? I knew in my heart she would want me to continue on. She also told me that if something happened to call her immediately, even giving me her home and cell number, so that she could call our anatomy course director and we would figure out what we were going to do about the exam. Honestly, I was grateful for the distraction of studying over the kept me from obsessing over everything that was happening with my granny and kept me from freaking out all weekend. But knowing that even if everything went to heck in a handbasket, even if the worse case scenario happened, that everything would be okay.....the exams would be sorted out was a huge weight off my shoulders and enabled me to focus more.
The weekend came and went. Granny was producing urine with diuretics so we knew by the end of the weekend that at least her kidneys worked.
The anatomy written exam Monday morning went as good as the previous exams, leaving me with 6 points needed on the practical to pass the class. Again, a huge relief to know I only needed 3 of 50 questions correct. I knew it was within my reach at this point. The practical went equally well, at least for me who traditionally struggles with practical exams at least in anatomy. I knew going home that anatomy was done and passed and things while hectic and crazy were okay...not great but at least okay.
I found out shortly thereafter how incredibly lucky we were that the doctor who had done my granny's D&C stopped when he did. The biopsy results of her uterus came back and while they showed no evidence of cervical cancer (a huge relief), they did show that there was a fibroid which was slowly eating its way through her uterine wall and was the source of her bleeding. If the doctor had continued her D&C, it is quite possible her bleeding would have dramatically increased and they would have had to do an emergency hysterectomy which would have placed her life in dangerous peril.
Tuesday came and went....status quo.
Wednesday came and when my mom called me after my exam I knew something was terribly wrong. That morning my granny had some episodes of Toursades de Pointe which precedes ventricular fibrillation. Thankfully they were able to shock her and stop the rhythm but they were very concerned about her health and heart. So i left school and went straight to the hospital. The labs came back normal, the CAT scan showed no brain damage so it was okay...he heart and brain were still okay. However, she was running a fever.
Her liver bilirubin levels though were beginning to rise. So now we had to worry about the possibility of liver failure and granny is not a candidate for any sort of transplant. The antibiotics she was on for her sepsis were causing damage to her liver and the one left they could switch her to was penicillin based and my granny is allergic to penicillin. Sp we watched and waited.
Then the good news began to trickle in. Her blood cultures began coming back negative which meant the antibiotics she was on were finally working and she was beating the sepsis in her blood. There were no more arrythmias and even though her bilirubin levels continued to rise she was not showing any signs of liver damage. They eventually switched her antibiotics to one that was less liver toxic and her bilirubin levels began to come back down. They took her off of the paralytics and began turning down her sedatives. She began breathing over the vent but was not quite waking up.
Then came the day when everyone held their breath. It was a Wednesday, she had been on the vent for almost two weeks and they needed to take her off. We were all warned about the disctinct possibility of granny having to have a tracheotomy and that was everyones main that woudl affect her health and recovery. But then came another huge step forward. They took out the vent tube and somehow someway she did not need a trach. She was breathing on her own. Then slowly she began responding to us. She would smile and crack her eyes open when you came in the room. Then her eyes were fully open and she woudl smile at you when you came but we had not really heard her talk much and when she did her voice was very hoarse.
Slowly, things got better. She began taking liquids and her bilirubin levels came back to normal.
Granny was well enough to be transferred to and acute care rehab faciloity where she is now. Since she has been there, she is taking more food in and her NG tube has been removed. They are slowly working on building her muscles back up and continuing to get her well enough to finish her rehab at a regular rehab facility. But where we are todat compared to where we thought we would be is nothing short of a miracle.
I told someone the other day that I must get my fight from her, along with my stubborness. When the chips were stacked against her, my granny showed what an incredible fighter she is. And somehow through it all, I managed to complete my finals and finish my second quarter of medical school.
What does this proves that life happens. We may never know when the next thing around the corner that may come and knock us off our feet, but it is those times that we find out how strong not only we are but how strong others are as well.
My granny continues to amaze me everyday. I know forevermore I will cherish the time I have with her, my family's miracle.

Tuesday, March 29, 2011

The yin and the yang

So it has been a while since I updated and there is so much to update about.

There is the good....passing anatomy, bruning scrubs, making closer friends, discovering the depth of my inner strength

And then there is the bad...the family crisis that happened right before finals week among other things.

The good is easy to write about...the good is happy to write about. It is easy to share the good. The good is what makes me glad I am here. The good is what marks the little steps along the way, the hard fought achievments and milestones that must be passed to cross the ultimate finish line.

The bad is what happens when you are looking elsewhere. The bad is harder to write about becuase the bad happens when you least expect it. The bad happens to you and turns your life upside down. The bad is hard to share because people will suprise you, and how do you share that? How do you expose yourself at your weakest, when you are most vunerable and show that you are indeed human? Do you dare shine a light on others, that they may think twice about their actions? But is that fair to do to someone, is it fair to do to yourself? It is the bad that perhaps needs to be talked about most, but at the same time once you put words to paper or print they are there. But then how do you vent about the bad, how do you express the frustrations of the bad, the sorrows of the bad, the hurt and betrayal of the bad without feeling bad yourself for having put it out there in the first place?

But this is what medical school is....ultimate triumphs followed by ultimate sorrows....sometimes occuring at the same time. My friend once told me some days you are the pigeon and some days you are the statue and some days you are the pigeon. I think that sums it up perfectly. There can be no good without bad, no triumph without sorrow, no hope without despair, They are sides of the same coin. The yin.....the yang....they are both part of one yet inseperable.

Perhaps in time I will blog more about the bad....but for now look for some future blogs about the good to come