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Editor's note: Chelsey Baldwin of Little River is a third-year medical student. This column follows the journey of her class in becoming doctors.
A new era in our education has begun. Third year is the time we shed the pre-prescribed recipes for achieving our academic and professional goals. Each student's training has become unique, shaped by our patients and the physicians, nurses and other professionals who care for them.
Despite reading over the various conditions our patients suffer from countless times in my past, the word associations finally begin to have concrete meaning beyond the loosely connected mnemonics and rhymes that got us through the last two years of medical school. Now patient stories, symptoms, and mannerisms live within the letters and rhymes of old memory tricks. The animations of such mnemonics began with my experiences on the psychiatry wards.
Toward the end of my six-week psychiatry rotation, I met patient X. She had spent the weekend in the emergency department because of a lack of available beds on our ward. During her time in our emergency department, she had received the diagnosis of bipolar NOS (not otherwise specified). Given the "NOS" status of our patient, we began our discussion with her focusing on her likely manic symptoms. Manic characteristics we summarize by: DIGFAST.
"D" is for distracted. Patient X took a seat in front of the team of health care workers during morning rounds. "Can you tell me briefly, Mrs. X, what brought you here?" I began the interview, fulfilling the designated role of the medical student in getting as far as efficiently possible.
"Let me tell you, my son has been friends with 'Joe' since they were this high," she gestured as she talked in a rapid manner. "'Joe' was always a sweet boy and he liked me the best of all the neighborhood moms. I'm the cool mom; the kids all hang out at my house, because I let them do what they want." I checked off "I" for irresposibility as she went on talking without so much as taking a breath. "Much cooler than 'Joanne,' who moved to the neighborhood back in... Oh, '97. She is probably jealous of me, but really it isn't my fault." "G" is for grandiosity.
"Mrs. X ..." my resident calmly intervened, "You were telling us why you were brought here."
"F" is for flight of ideas.
"Oh honey, I know. I was getting there. Well my son never brought 'Joe' over to hug me, and that's the first thing he normally does when he comes to town. So when I saw my son, I confronted him." The patient jumped up to act out her and her son's interaction. She drew herself upright and looked down her nose at her imaginary self as she mimicked her son.
"A" is for increased activity. "You're not my mother," she shook all over as she mimicked her son. She spun around to resume the role of herself, clasping her hands at her chest. 'Son, yes I am your mother.'"
"S" is for decreased sleep, a question we were never able to squeeze into her narrative. However it's easy to observe "T," for talkativeness. Despite 30-plus minutes of a group effort of trying to guide Mrs. X to make sense of her presence in our mental health facility, we were left with little more than an understanding of neighborhood dynamics. We resolved to try again later.
After psychiatry, I began an obstetrics and gynecology rotation. I teemed with excitement at the chance to deliver a baby. However, one of the first deliveries where I was present was surrounded by circumstances of an extremely ill mother.
Preeclampsia I remember by the letters: PRE. "P" is for protienuria. Ms. Z was a young woman at 28 weeks pregnant with her blood pressure ranges of 170s/100s and protein in her urine. "R" is for rising blood pressure. Shortly after her arrival, I went to the room to introduce myself and conduct a physical exam. She looked acutely ill, flushed cheeks, sweat at the roots of her hair. She complained of an unbearable headache, undoubtedly caused by the elevated pressures coursing through the arteries of her head. I prodded her about pain in her upper right quadrant, as I imagined a swelling liver, a part of the constellation of findings in the still unclear pathophysiology of preeclampsia. The skin of her lower extremities remained indented after I pressed my fingers onto her shins. "E" is for edema. I tapped her on the patellar tendon, and her leg jumped so rapidly and with such force that it startled me.
Hyperreflexia, associated with worsening preeclampsia. I finished my exam and excused myself.
My resident met me in the hallway. "Chelsey, what are the risk factors for this patient predisposing her to preeclampsia." Luckily, or not, I had been "prepped" on these by an attending the previous morning and had to learn them the hard way.
"This is her first pregnancy, she falls in the bimodal age range, and she has a history of chronic hypertension."
"What is the treatment for preeclampsia?"
"Delivery," I said and with that answer, I knew we were in for a long night. She was one of four Cesarean sections scheduled to take place before the morning shift began.
As our pneumonics come to life, the heaviness of memorization lessens. We are able to spend less time rhyming and more time understanding. We are indebted to those that we are able to learn from. I'm often delighted with what ease our patients will reveal the hidden workings of their bodies and their eagerness to be a part of our journey to physicianhood.
*The specifics of patient conversation have been modified to protect the anonymity of patients
Friday, Oct.
12, 2012
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