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Exposure to in-depth pathology a welcome change

Editor's Note: Chelsey Baldwin of Little River is a second-year medical student. This column follows the journey of her class in becoming doctors.

In a lecture hall, located on the first floor of the Basic Science Building, we watch as our patient enters anaphylactic shock. Our instructor, Dr. Matthew McEvoy, tells us that we've been called to the bedside of a patient who has begun to code. The attending will not arrive for another 15 minutes. "What do you want to do?" he asks us.

At the front of the lecture hall, a screen displays the patient's dwindling blood pressure and oxygen saturation, accompanied by an elevated respiratory rate and a racing heart that is attempting to make up for the lack of circulating volume. The alarms continue to sound.

"What are you going to do?" Dr. McEvoy prods us again. The unrelenting sirens are unnerving and lead to a momentary lull in the auditorium. Despite the fact that this patient is no more than a set of vital signs on a screen, the hesitation, the need to be right is still present.

McEvoy aids us by pointing to the patient's non-life sustaining blood pressure. "Fluids!" we shout. "The patient needs to be given intravenous lactated ringers," another student confirms. Much of the patient's blood volume has been lost due to increased permeability of vessels, which we need to correct for quickly in hopes of avoiding considerable comorbidities.

"What drugs should be administered?" We shout out a list of adrenergic drugs we have recently, and less than confidently, committed to memory. Working through our buzz words: Shock: Anaphylaxis: Epinephrine. "Give them Epinephrine!" we call out.

"How much?" Dr. McEvoy banters back at us. "High Dose!" Dosages beyond high and low are still a mystery at this point. McEvoy simulates the addition of a high dose of epinephrine to our patient.

"Now your patient begins to wheeze!" he tells us.

"Good" we cry. It's a sign that bronchoconstriction has begun to resolve just enough to allow air to whistle through the respiratory passages.

The patient's vitals begin to normalize.

In-depth exposure to pathology has been a much welcomed change from the first-year curriculum. Recognition and understanding of disease is what you ideally imagine medical school to be, often omitting the year of learning "normalcy" that precedes.

I often cringe as I go through our syllabus laden with images of the horrible deformities and damages that can befall upon the human body. Exposure to the endless ways in which the body can be induced into a diseased state also has induced bouts of hypochondriacal thinking. Take for instance, after a week of continuous 15-hour study days for our last exam, my legs began to ache. Sedentary, with painful legs, good heavens, I have a deep venous thrombosis (DVT). I monitor my breathing, waiting for the onset of a pulmonary embolism.

I am far from the only student I've heard grumbling about DVTs in the past week. This mindset is obviously far from a new phenomenon within the medical student population. Our professors are cognizant of our hyper-self-diagnostic tendencies.

Dr. Sally Self, pathologist and College of Medicine lecturer, lists out general vague symptoms of vasculitis: weakness, fatigue, and malaise. She stops, "No you don't have vasculitis; you're just not exercising and sleeping enough."



Friday, Oct. 7, 2011

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