Brain Flop: Multiple Causes of Chest Pain?

Second year of med school at the UW has a lot of book learning, but the school also does a good job of trying to ramp up our clinical skills in preparation for spending 3rd and 4th year in hospitals on various rotations. The Introduction to Clinical Medicine course is class that tries to guide us on the path to becoming good doctors, and it is through this course that our second year clinical experiences take place. The Medical School has 6 different "Colleges" or sort-of families that students get randomly assigned to when they start medical school. They are:

Denali = my college (which is, of course, the best!)
Rainer
Columbia River
Snake River
Wind River
and Big Sky


Within the Colleges, students also get assigned to a "College Mentoring Group" with about 5 or 6 other students. Your College Mentor is an experienced physician who guides and supports you through you medical school and who plays a large role in your clinical learning in second year. Throughout second year we go to a hospital with our College mentor and the other students in our mentoring group and interview patients and practice our physical exam skills. Each student completes 2 completely histories and physicals a quarter, presents their patient to their group, and completes a write-up about the patient. (It is a lot of work, but we learn SOOOOO much through this experience).

This is a picture (off the school's website) of Sam who is our Denali College Mentor. Sam is awesome. He is really good about giving very helpful feedback, but in a kind and supportive way. (I will try to post an update picture of our entire college mentoring group next quarter. I kept forgetting to take pictures this quarter).

Anyway, towards the beginning of the quarter I interviewed a very nice patient who had been admitted to the hospital because of chest pain. I didn't get through everything, but I finished as much of history and physical as time would allow. Then I presented the case to my mentor and mentoring group classmates. I was really nervous and my mouth was dry and my hands were shaking while I was presenting the case. Then we got to the end and our mentor asked me: "So what are some of the most likely causes of the chest pain?" I froze and I couldn't think of anything to say other than a possible myocardial infarction (a heart attack). My mentor smiled and asked with an inquisitive look if I could possibly think of anything else that could cause chest pain. I swallowed slowly and quickly tried search my brain, only to find that it was completely void of any useful knowledge. In fact, the only thing present seemed to be the word, "uh?" echoing through my skulls empty chambers. I looked at the floor and said that I couldn't think of any other possible causes of chest pain. I was embarrassed then, but it was nothing to how I felt once I got home and looked up "Chest Pain" in my physical exam book. The possible causes of chest pain and almost countless. Just a few that I found were:

-myocardial infarction
-cardiac arrhythmia
-aortic dissection
-pericarditis
-pulmonary embolism
-pneumonia
-lung cancer
-pneumothorax
-pleural effusion
-hyperventilation
-anxiety
-depression
-reflux esophagitis
-esophageal spasm
-peptic ulcer
-gastritis
-pancreatitis
-biliary colic
-cervical arthritis
-costochondritis
-herpes zoster

I can't believe that I couldn't think of just one more from the list. I guess we are still a long way from becoming doctors. Hopefully, we improve a lot this year!

A shameless fundraising plug: EEP - Orphan Sponsorship Program

When I was in Uganda in 2007 I volunteered for a Canadian organization called Working to Empower. One of the activities I helped with while I was there was their orphan sponsorship program. The program helps female orphans attend secondary school which increases their status in society, breaks the poverty cycle and makes it less likely they will be infected with HIV. I wrote a couple articles about the program while I was in Uganda and got to talk to some of the girls going to secondary school. They really are good kids and have a lot of hopes and dreams. Anyway, if you are looking for a good thing to donate to, check it out:


http://www.givemeaning.com/project/wteeep

(GiveMeaning site is hosting the fund raising efforts for the program)

Still some time for some fun...

Although I may spend many hours studying, I still have plenty of fun. In addition to seeing friends and family, I enjoy spending time with my roommate, Melissa, and her cousin.

I thought this picture was pretty funny. Melissa is a fourth year medical student and she made blueberry muffins for her call team that she works with at the hospital. However, she put the muffins in containers too soon after getting them out of the oven, so the next morning the muffins were a little on the soggy/moist side. I was cracking up as Melissa used a hair dryer to dry out her muffins. I think many years from now this picture will symbolize the good times I have had in this house.

Sorry that I haven't posted for a while, second year is kicking my ______

I am sorry that I haven't posted anything on the bl0g for a while. The only (extremely lame) excuse I can give is that the second year of med school is kicking my______(this word has been omitted in an effort to keep my blog G-rated and family-friendly). I am currently in a state of post-test euphoria so I will spend a few minutes giving you a quick update on my life.

I just started the 7th week of our 15 week "quarter," and we have already completed 2 classes! We have 5 hours of class Monday-Friday and our classes are divided up into quarter-long classes and block classes. Pharmacology and Introduction to Clinical Medicine II last the entire quarter while other classes only last a few weeks. The first class, the Skin System, we completed in only 2 weeks. The second class we just finished was Endocrinology and that class lasted about 4 weeks. Some good news: I passed both classes! Whew! Those of you who talk to me (which we know really means listening to me freak out) regularly know that I was particularly concerned with passing Endocrine. In the end I passed the course and decided that I really liked the material - endocrinology is absolutely fascinating! Now we are studying the Cardiovascular System and the Urinary System as block classes.

The REALLY good thing about second year is that the material we are studying is much more interesting and is directly applicable to taking care of patients which makes studying it more fun. Learning in detail about different aspects of the human body is fascinating and it makes you feel smart too! Therefore the 4-6hours you have to study each day to stay caught up seems much more bearable than the study load last year even though we have more work.

In addition to coursework, I have had a few other things on my plate. My laptop I use to take notes on everyday, gave up the ghost and is currently being repaired (thanks to the Staples warranty). Also, for my trip to Uganda last summer I had to create a poster about the project I conducted in Kumi making shoes for diabetic patients. The poster was due earlier in the quarter, but I will be presenting it at the School of Medicine Poster Session in November.

Here is my poster. It might be hard to read on the blog, but you can probably get the gist of the information. It is a lot of work to try to line up all of the boxes on the poster!


As far as my study methods go, I am probably don't have the most efficient methods possible, but I have been doing anything I can possibly think of to help me learn the material. Recently this has taken the form of using many different pen and highlighter colors with my studying to keep things interesting.

This photograph is the current artistic representation of my life - studying a lot! Featured here are my Endocrinology notes, my pens and some of my highlighters. When I put a full day of studying, I go through an average of a highlighter a day or a pen every other day. I know, I live an exciting life.


Here are the coursepacks for the two conquered subjects so far - Skin and Endocrine. A long time ago I used to have this reverence for textbooks. I somehow thought that it was wrong to write in them, highlight excessively or otherwise defame such a precious source of knowledge. Now I have a completely different approach - textbooks are my slaves! Their purpose in the scope of the universe is to help me learn and therefore should be abused in anyway possible that can help me understand the material. These abuses may include, but are not limited to: highlighting, annotations in the margins, scribbling in frustration, or the writing of sarcastic commentary/mnemonics. In case you were wondering, my highlighting color scheme does have a rudimentary logic: yellow is mildly important, green and blue are moderately important, and orange and pink are extremely important/pay attention! If a figure or concept is very important or hard to grasp I write a summary statement in the margin. Therefore, when it is time to review for an exam I can go through and read the orange, pink, green and blue highlighted text, review figures and read by notes in the margin and come away with a pretty good review. OK, now you probably know way more than you ever wanted to about my study habits...

How do I feel these days? Well, a picture is worth a thousand words... :)