Today, I feel like a medical detective.

A 67-year-old man, a heavy smoker goes to the hospital to investigate the origin of his chest pain. The lab parameters and blood gas values are: Na+: 138 mmol/L, K+: 4.8 mmol/L, glucose: 5.2 mmol/L, creatinine: 98 mmol/L, pCO2: 55 mmHg, pH: 7.32, actual HCO3-: 40 mmHg, BE: 4.2 mmol/L. What kind of acid-base disorder do you suppose? What could be the cause of the disorder?

Our physiology lab manual posed this and some related questions to prepare us for our acid-base balance experiment. The topic itself has been dense to study and wrap my brain around, so it was nice to see the knowledge applied in this direct, clinical way.

My diagnosis: compensated respiratory acidosis due to COPD.

Today’s a big day in college basketball! Duke is playing UNC in enemy territory. In the name of all the -arkies, GTHC, GTH!

Inside Cameron! 2010

Inside Cameron! 2010

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Today, I’ve been a long time gone


(What beautiful harmonizing and an unexpected pairing from these two musicians!)

After 4 weeks, 3 exams, 2 decidedly unfestive holidays, and 1 lovely visit from my mom, I can finally say that the fall 2013 semester is in the books. I’m already dreading doing it again in May, but I’ll try to just live in the moment for a bit. It’s an odd feeling to be so free – kind of like when I stopped piano lessons after many years, and couldn’t shake that feel of “what am I forgetting?!” when I didn’t practice.

Now, I’m on a full-out media binge (TV shows, books, magazines, music I’ve neglected since October) and making plans for the next 2 weeks of break. Any recommendations to add to the list?

Today, I operated on a rat.

Physiology labs at the beginning of the semester started off on the boring side of interesting because many of them were conducted with computer simulation software (we had SimNeuron, SimMuscle, … you get the gist) that generated the data for us. Some time in the last few weeks, though, the labs have gotten interactive and fun! It started off when we measured the effects of certain vasodilators and vasoconstrictors on a biopsied rat aorta. We’ve also done ECGs one one another, taken blood pressure in various physical states, and listened to heart sounds to complement our cardiovascular unit. Today’s lab was probably the pinnacle of the semester: each lab group operated on a live, anesthetized rat to study the effect of vagus stimulation! Even our professor had been looking forward to it for a while. At the last class, he reminded us enthusiastically that it was “VAGUS, BABY!” coming up 🙂

Lest the word “operate” gives the wrong impression I will preface by saying that each rat was sacrificed after the experiment with a high dose of KCl injected into the heart, while still under anesthesia. I think and hope it did not suffer at all.

MedDramaPoster_lg

Our standard white lab rat came to us fully sedated by the lab technician. We picked it up and laid it out on a glass stretcher. The first task was to cut open the chest and find the trachea for intubation. Strictly speaking, this was not necessary for the vagus investigation, but it was a good experience for us to have. This required “atraumatically” tearing through some layers of muscle and making a “T”-shaped incision in the trachea through which a cannula was inserted, all of which Rina did expertly!

Then, we located the carotid artery, which is relatively large and easy to identify because of its pulsation. The vagus nerve, in contrast, is a minuscule strip on the underside of the artery. Priyanka and a Hungarian student joining us for the day separated the nerve, and placed an electrical insulator under it. For the next part of the experiment, we inserted subcutaneous ECG leads, placed an electrode on the nerve, and measured the heart rate. (Because of the nerve’ parasympathetic function, stimulation of the nerve led to a reduction in heart rate. Administering atropine, a parasympathetic antagonist, reversed the effect.)

Afterwards, the official experiment was over, but we dissected the rest of the rat to see its internal organs, all so similar to humans’ viscera. The set-up looked something like by then: this [warning! not for the squeamish]. We also cut into the head and removed the brain. Although some found this extra dissection a bit gruesome, I felt better knowing that we got the most out of the sacrificed life.

Initially, I was actually bit skeptical that the lab experiment was worth the life. Couldn’t this be one of the simulated ones? In retrospect, though, it was about more than the physiology of the vagus nerve. It was the first time I had ever cut into something living, and also the first time I killed a mammal (not that I kill other classes of animals on the regular or anything, but I have no mercy when it comes to bugs!). It’s a different facet of medicine from all the theory stuffed into our heads these years, and one necessitating a prepared emotional response. This was “just a lab rat”, but soon, it won’t be!

Today, I share Megan’s photos!

Megan captured some beautiful photos of Budapest and our non-costumed Halloween weekend together in her latest blog post. 🙂 I was WOWed — the riverbanks have never looked more lovely.

Gotta run, anatomy midterm tomorrow. Second year continues to be a nonstop funfest.

Today, I learned how to stop hiccups.

We had an anatomy lecture on the vagus, accessory, and hypoglossal nerves today (CN X, XI, XII). One of the only things that I remember from it is this trick to stop hiccups:

Press down very hard right behind your ears.

Hiccups can be cured by stimulating the vagus nerve, and there is a branch of it that runs behind there. In fact, there’s a whole bunch of information on vagal hiccup remedies.  Let me know if this particular one works for you!

 

Open Mind, Open Window

“When I was 19, I was a completely different person than I am now! I wanted to be a radiologist.”
– Surgeon on Grey’s Anatomy

I entered medical school with a directed idea of what patient group and illnesses I hope to work with, but I’ve always told myself to be receptive to the breadth of possibilities. Today, we had our Introduction to Clinical Medicine class in Neurology, and I was reminded to keep on exploring other branches! The neurologist who led the class brought in two patients and presented their symptoms, allowing a few students to perform parts of the neurological exam as well. What we’re learning is slowly coming together: the first patient had Parkison’s Disease, and we discussed dopamine synthesis (last semester’s biochem), muscle tone (last week’s physiology), and motor pathways (what we’re currently studying in anatomy). It’s a lot to integrate, but that’s what also makes it exciting.

Sometimes, glimpses of nature fill me with wonder. This flash of foliage outside did just that.

Flash of foliage by the main entrance of the Neurology clinic.

Today, I’m suited up!

WHY HELLO!

Friday again, and the days are blending into one another this semester as an endless cycle of study, sleep, eat, class … in fact, the main difference is where we have our Introduction to Clinical Medicine session each week (last time was in the Pediatrics clinic). This Wednesday, we suited up for (watching) surgery!

Sophie and I after putting on our colorful gowns.

Sophie and I after putting on the colorful gowns.

I didn’t go into the OR because I wouldn’t have been able to see anything from my vantage point, but I did get a lot out of our tour in the ICU. The physician gave us a history of each patient there, e.g. their pre- and post-operative statuses and difficulties encountered in their treatment. One notable procedure mentioned was the gastric pull up esophagectomy, in which the stomach replaces the esophagus.

Other than that, I feel as though I’m at the base of a mountain of reading. Off  I go to start my climb.

Happy weekend, y’all 🙂