Billy Rubin

The adventures of a pre-clerkship medical student.

Thursday, September 28, 2006

The Brain on the brain

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Wednesday, September 27, 2006


Studying neuroanatomy, I have come across pictures like these representing the relative areas of the brain associated with sensory input or motor output. Our mouth and hands require very fine movements to speak and write. They also have a great deal of sensory input. These Homunculi are essentially how our brains view the rest of the body.

From this image one can deduce that, in sensitivity terms, a large mouth ulcer could be more significant than ones tackle - not a pretty thought.
-- From the Mouth Ulcers Homepage

(sensory homunculus on left and motor homunculus on the right)


Saturday, September 23, 2006

Systolic Murmurs

We sat in a semicircle unsure of how to proceed. Our clinical skills class commonly had us examining volunteers, but this was an entirely new challenge for us. Men and women in various states of undress would allow us to listen to their hearts, bend their knees and percuss their chests. They gave us the opportunity to learn and over time our fumblings became more experienced palpations, our ears became tuned to the sounds of the lungs and heart, and our eyes began to recognize atrophy and distress. As medical students we became familiar with the unfamiliar, but this was something different again.

Seated in the centre of the semicircle was today's volunteer. She had bright blue eyes and golden yellow hair. She smiled brightly as she played with a toy dog. Her name was Sarah. And she was a bright and beautiful four-year-old girl.

Sarah was very outgoing and engaging. She put us at ease quickly as she shook each of our hands, in turn, as we introduced ourselves.

Slowly we began to make our way through the Denver. Sarah was eager to perform the tasks. She hopped on one foot, drew shapes and completed sentences. She correctly answered questions well past her age bracket, reveling in the adoration she received after completely the assigned task.

Finishing the Denver, we moved on to the physical exam. Before listening to her chest, we had Sarah listen to each of ours. Placing the stethoscope on my chest, Sarah mouthed what she was hearing. "Swoosh."


"Yup. Swoosh." Sarah smiled. My mind flooded with the horrendous possibilities this entailed. I began drowning in thoughts of systolic murmurs. I thought about young relatives who had died or coronary heart disease. I AM TOO YOUNG TO DIE!!


My eyes focused on the small girl standing before me. Her small hand held the diaphragm to my chest. Her tiny face was encircled by the larger headset. She smiled at me, looking for approval. She was unaware of the implications of "thump, swoosh, thump". I weakly smiled back at the four-year-old who had just diagnosed by heart valve stenosis.

Sarah checked everyone's heart. "I don't hear anything," she said to the first student. She told the second student she heard, "Bang Bang Bang." The third was informed that she heard "Ka boom!" The worry quickly melted away, as I realized she had just diagnosed my fellow classmates with having no heart, CHD, and, the ever common, exploding heart, respectively.

Image credit.


Saturday, September 16, 2006

If I asked you about art...

I've been in school a very long time. More than eighty percent of my life has been spent in a classroom. Preschool. Elementary School. Highschool. An undergraduate degree. A year of honours research. Two years of masters research. And now a couple years of medicine. It's been a long time. And at moments like this, when it's Saturday night and I have spent the entire weekend studying and there's seemingly no end in sight, it feels even longer.

I want to be doing something. I don't want to be reading about medicine; I want to be practising medicine. I want to be able to feel the lump in a person's neck and not just read about the cytogenetics of lymphoma. I want to diagnose a patient and not just study the tests to order. I want to write a prescription and not just sit here reading about drug-drug interactions. I want to be a doctor and not simply be reading about what a doctor does.

I do realize that studying is a necessary evil. That before I can examine a patient's neck I have to know what I'm looking for. Before I make a diagnosis I have to know what the test results mean. And before I can put pen to prescription pad I have to know the drug, the dose, and the side effects. I understand that the books are necessary before I get to real deal, but that doesn't mean I won't be glad for that day to come. And hopefully all this studying will be put to good use.

So, if I asked you about art, you'd probably give
me the skinny on every art book ever written.
Michelangelo. You know a lot about him. Life's work,
political aspirations, him and the pope, sexual
orientation, the whole works, right? But I bet you
can't tell me what it smells like in the Sistine Chapel.
You've never actually stood there and looked up at that
beautiful ceiling. Seen that....If I ask you about
women, you'd probably give me a syllabus of your
personal favorites. You may have even been laid a few
times. But you can't tell me what it feels like to wake
up next to a woman and feel truly happy. You're a
tough kid. I ask you about war, you'd probably
uh...throw Shakespeare at me, right? "Once more into
the breach, dear friends." But you've never been near
one. You've never held your best friend's head in your
lap, and watched him gasp his last breath looking to
you for help.... I can't learn anything from you I can't
read in some fuckin' book.
-- Sean speaking to Will in Good Will Hunting


Friday, September 15, 2006

Long Way From Home

Anne was a long way from her home. She stood on the wharf, suitcase at her feet, and gaped at the three-story building that stood in the center of the small town. The clinic was no bigger than the house in England she grew up in. This couldn’t be all there was. Could it?

She turned back to the water to see if she could catch the boat before it had left. The small dory was already halfway out of the harbour, smoke rising from the fisherman’s pipe as he methodically rowed away. He had been hired to transport her to this town, given there was road access. His job done, he had left immediately. The journey back was a long one and would take the remainder of the day.

Anne picked up her bag and trudged toward the small cottage hospital. She had been trained as a nurse and midwife in London. With senior positions being filled and little room for advancement, Anne began looking for positions outside the United Kingdom. Health boards in Australia required three year contracts, a seeming eternity to a twenty-two year old. Newfoundland was offering 1 year positions. Anne could sign up, work one year, and, having experience, look for positions back home. And now she found herself her, at the God-forsaken end of the Earth. No road access. No amenities. No trees! Just a small group of houses huddling together against the barrenness.

“Hi. You must be Anne. I’m Gertrude.” A plump middle-aged lady stood before her, clad in a white nursing dress and cap. “Would you like a tour of the hospital?” Without waiting for an answer Gertrude turned and began up the steps. The third floor was one large open room housing three beds. The nurses slept there. The second floor contained a small ward. Their clinic was on the first floor. The nurses slept upstairs and worked downstairs. There would be little time for anything else.

Anne lay in her bed, head under the covers, crying silently. What had she gotten herself into? How was she going to get through this next year? This couldn’t be happening. It must be a dream!

Little did she know that this small Newfoundland community would be where she’d stay. She would treat everyone and everything without exception. She would eventually lose track of the number of babies she would deliver. Children would be named in her honour. She would pull teeth, set bones, treat animals, and prescribe medications. Along with Gertrude, she would become the town’s entire medical system. And this town would become her home. She would marry a local man and have two beautiful children. She would become a grandmother. She would retire here, but she would still stay. She had found her corner of the universe. She had found where she belonged. But that first night, lying under those blankets and crying silently, she just didn’t know it. Sometimes life takes you not where you want to go, but where you're meant to be.


Friday, September 08, 2006

Bad news

They sat in the waiting room, not knowing what to expect. It had been two weeks since he had discovered an egg-sized lump in his groin. He called his family doctor and made an appointment. Upon seeing the physician, the mass did a disappearing act. It had taken a couple of trips back, but the doctor had finally found the mass he had felt. Within a day or two he had been sent to a specialist. Upon examining him, the doctor was obviously shocked. Disquieted by this, he repeated asked what was wrong. But no answer had been forthcoming. The doctor simply said she couldn't be sure until the lab tests come back. And now he sat, wife by his side, in his GP's waiting room, wondering what secrets those lab tests would reveal.

The GP walked out and called them into her office. They sat. The doctor began to cry.

"Tell us what's wrong?"

"You're full of it!"

"I know he's full of it, I've been telling him that for years!" his wife joked.

The doctor sobbed. "You're full of cancer!"

He began to cry. Large tears rolled down his cheeks. He shook as waves of grief rolled over him.

In twenty-five years of practice, she had never had to give someone such a bad report. The prognosis was poor. She was as devastated as he. Together doctor and patient wept. She had had the uneviable job of telling him he had cancer and he had had the uneviable job of hearing it.

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