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Archive for the ‘Med school’ Category

Go West, young woman

I am no longer Schrödinger’s resident

 

A week ago today the verdict arrived.  I am Utah bound to pursue residency training in Family Medicine.

 

I am thrilled.

 

I fell in love with Utah when I travelled there for a wilderness medicine elective last spring.  With scenery like this, can you blame me?

 

Alpine pic of the day

River pic of the day

Desert pic of the day

Moab- More than expected

 

That wasn’t my first trip to Utah, as I had previously visited Salt Lake City for the first Physicians and Ancestral Health symposium.  Knowing some ancestrally/evolutionary-minded physicians in Utah and at the institution I am heading to definitely played a role in my ultimate decision to make Utah my top choice for residency.  Add in excellent clinical and academic opportunities, on top of happy and interesting faculty and residents, and I know I’ve made the right choice.

 

I’m really looking forward to this exciting new chapter in my life, though not before I get in a couple more months of travel and adventure! (I head back to Ecuador on Tuesday!)

 

Desert Solitaire by Edward Abbey has been on my "to read" pile since my time in Canyonlands last spring. It has now been bumped to the top of the list.

Desert Solitaire by Edward Abbey has been on my “to read” pile since my time in Canyonlands last spring. It has now been bumped to the top of the list.

 

 

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It’s Match week.

 

If you know a fourth year medical student (or recent med school graduate like myself), you might have noticed them looking a little frazzled this week.

 

I’ve written previously about “speed dating for medical students”, where I briefly discussed the process by which recent (or pending) med school grads find their first jobs as interns and resident physicians.  The process starts when students apply to programs in their specialty (or specialties) of choice, at the end of the summer.  Pretty soon (hopefully) offers to interview come in.

 

Interviewing is an educational, though stressful, experience.  You get to see how different programs and different hospitals are run, you get to hear about life as a resident from new young doctors, and you get to meet fellow applicants who aspire to specialize in the same discipline.  Throughout the interview season you develop a bit of a patter- you come to expect some questions and you recognize what are the interesting elements of your personal story that people want to know about.  Interestingly, at least to me, very few people were interested in hearing about my PhD research.  Rather, they wanted to know how I intended to use my skill set in my future career.  “Where do you see yourself in 5 years.”

 

Of course, it’s kind of hard to say where you see yourself in 5 years when you don’t know where you’ll be in 6 months.

 

New physicians are assigned their internship and residency positions through a process called “The Match”.  By the end of the interview season, a student creates a rank list, in which they order the training programs for which they would be willing to work. This list must be eventually be finalized and “certified” (this year the deadline was 9pm EST February 26th).

 

Students aren’t the only one’s making rank lists; programs rank applicants in the order in which they want to employ them.  Once the student and program lists are certified, they are sorted by an algorithm designed to fit a theory that won Alvin E. Roth and Lloyd S. Shapley the Nobel Prize in economics.  You can read more here.

 

Once lists are certified and the deadline has passed, computers whir and crank to determine where students will be heading come June.  Students and programs get the results this week: “Match Week”.  The process starts on Monday, when students get an email answering the question “Did I match”.  At this point, residents are much like Schrödinger’s cat- simultaneously matched and unmatched, hanging in limbo until the email is opened.

 

I’ll admit that, despite being someone who tries to remain rather cool, calm, and collected (ok, that’s a lie, but I try not to worry about things that are outside my control), I experienced a significant amount of stress leading up to Monday.  Blame it on the fact that last year I was in the room when a generally very competent future physician received a “you did not match” email, but I couldn’t help myself from running through the series of events that would see me unmatched (I didn’t rank that many programs and all it takes is being one slot too low on each programs rank list and you find yourself scrambling for a supplemental offer).  Fortunately, Monday’s email brought me good news, and I am now on the eve of finding out where I will spend the next 3-4+ years of my life.  I, along with the majority of med students around the country, will be receiving my match information tomorrow at noon EST at a match ceremony at my school.  At this point I know I’ll be headed to 1 of 7 programs in 1 of 6 states…

 

Have stethoscope, will travel...

Have stethoscope, will travel…

 

Schrödinger’s resident is matched, tomorrow we’ll know where. Stay tuned!

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Thanksgiving

There are so many things that are worth writing about on and around Thanksgiving. 

 

For those of us interested in ancestral health and evolutionarily-appropriate eating it’s fun to explore what a pre-pilgrim Thanksgiving feast might have been.  Yesterday I spotted this article on Twitter discussing what a pre-pilgrim dinner would have looked like in Portland (the location of my penultimate residency interview!).  It is well worth a read.

 

My Thanksgiving feast this year is certainly of the ‘more traditional’ pilgrim/post-pilgrim variety, and will consist of a locally raised wild turkey and a Bourbon Red – a heritage breed turkey.  Incidentally, I don’t expect any Wild Turkey Bourbon will be consumed…

 

Thanksgiving is also a great, and thoroughly appropriate, time to talk about what we are each thankful for.  Family, friends, food, shelter, health; even the ‘least fortunate’ amongst us in the developed world are incredibly blessed when we look around the world and see those without access to clean water, basic medical care, or basic freedoms and security.

 

As I reach the end of my med school career, and pathologically over-think my future options, it seems like a very appropriate time to look back and think about what I am most thankful for from this rather lengthy journey.  Without a doubt, the thing I am most grateful for during the last 8.5 (*gulp!*) years is people.

 

As some of you may know, it was never my intention to be a doctor.  Truth be told, I never would have taken the MCATs (Medical College Admission Test) if my summer roommate hadn’t dared me to do it.  Nipa, though you won’t be reading this, Thank you.  On the day that I took the test I met a charming and chatty pre-med while we waited in line.  She thought my light-hearted approach to the MCAT was hilarious and offered me her AIM screen name so we could chat if I decided to apply to med school.  Without Jackie my AMCAS (American Medical College Application Service) application would have been submitted sans-personal statement, an act that certainly would have doomed my efforts.  Incidentally, Jackie and I ended up attending the same medical school, so I’ve had the opportunity (even as recently as a couple of months ago, since she pursued residency training locally) to express my thanks to her.

 

My large university had a “Pre-health” office that assists aspiring health professionals prepare their application for medical school.  When I called to ask if they would help me (only a month or so before applications were due), they told me that they could help me get my application ready… for the next year.  Fortunately the pre-health office at the woman’s college campus was willing to take me on (despite the fact that I wasn’t from her college), making my application to medical school a reality.

 

The day before my first medical school interview my college roommate asked me what I was planning to wear for my interview, telling me “I think people wear suits for med school interviews.”.  I laughed this off, but after a last minute email exchange with my advisor my roommate went shopping with me to help me find an appropriate suit.  I alternate between cringing and chuckling when I think about the response I would have received had I shown up to a med school interview in a tank top and cool Malaysian Sarong, my original plan!  Incidentally, prior to my residency interviews I headed to Long Island to meet up with this same friend for another suit-shopping experience (this suit is much sharper, if I do say so myself!).

 

I applied and interviewed for more PhD programs than I did MD/PhD ones (though since I only interviewed at four PhD programs that’s not saying much!).  I was very tempted by two of the stand-alone PhD programs, and my decision to pursue the combined degree literally came down to the final day.  I remember the day before the decision was due I met with an MD/PhD student who sold me on the virtues of a combined program.  Without Jay, it’s entirely possible I would have opted for a non-clinical route.  Another good friend, who’s opinion I still very much value, had warned me that “No sane person puts herself through the torture of med school unless she’s sure she really want to be a doctor.”.  I’m not saying he’s wrong- I’m sure there’s quite a list of people who have questioned my sanity over the years!

 

Someone who has contributed more to my medical education than he shall ever know is Russell.  I thank “Russell”, though I shall never know his real name.  Russell was a 74-year-old man who died of “coronary artery disease”, at least that’s what his cause of death was listed as.  While I became very familiar with his body, I will never know anything about his life.  From his lean and muscular body (Russell was short for “Russell the muscle”), I imagined him as a fit and active man, but I shall never know.  Books have been written about gross anatomy lab (including one written about the experience at my school- my anatomy teacher is on the cover of this book!), and I’m sure every student has a slightly different experience of this ‘right of passage’.  I feel safe saying that we are all, uniformly, thankful for the gift that our donors gave.

 

I’m not going to go through and thank all the people who helped me survive (I would not call it thrive) in medical school.  Completing my PhD was a particularly stressful time, and I am forever thankful for the many people who supported me through that experience.  Returning to medical school (after 4.5 yrs in the lab) was difficult, but made much easier by classmates who did their best to get me up to speed on the floors.  The three guys I did my first neurology rotation with were particularly kind in helping me hold-it-together while stressing out about how to present a patient to our attending physician for the first time.

 

I would be remiss for not recognizing the role that many of my residents played in my development as a future physician.  Some residents love to teach while others barely tolerate students, but even the grumpiest and most sleep-deprived resident shaped my experience in someway (for better or worse).  Likewise, various attending physicians have been mentors that I struggle to recall while others have truly fashioned some aspect of my clinical or personal development.

 

It takes a village to raise a child, but it takes a hospital to make a doctor.  When you are a medical student or resident-physician, nurses, physician assistants, therapists, and social workers can make or break your day.  The reality is that these people frequently know more than you about what your patient actually needs.  Speaking of patients- they are, of course, an integral part of medical education.  Many are lost in my memory, but others will stay with me throughout my clinical career, for the impact they had on my medical knowledge and the impact they had on me personally.

 

As important as all of these people have been to my development as a clinician and a person, I am most grateful for my friends. I have loved the poem “A Prayer” by Frank Dempster Sherman (1860-1916) since college, and as I travel around the country interviewing for residency programs (and catching up with friends along the way), it has never struck so true.

 

Screen shot 2013-11-27 at 3.10.34 PM

 

I have a fantastic network of friends, one that I am truly thankful to have nurtured over the years.  In an era when the word “friend” may conjure up thoughts of a virtual connection on facebook (especially when in the same sentence as the word “network”), it can be easy to lose touch with people that matter or let friendships devolve into a series of “likes” and “pokes”.  On the other hand, online social networks can help make connections that have been lost.

 

When I interviewed in Vermont I met up with a friend I have not seen since High School. On my way home from an interview in New Hampshire I spent the weekend catching up with friends in Boston. Before heading to Colorado for an interview I went to play polocrosse (imagine a combination of polo and lacrosse) for the first time in 2.5 years, in Texas.  There I saw friends that I have literally not seem for years, but who opened their homes and stables to me without hesitation.  With the exception of one upcoming interview, all of my interview travels are combined with a visit with one or more friend.

 

When I entered medical school I was unsure whether I would ever use my clinical degree in practice.  The medical knowledge would be useful for asking relevant research questions and the clinical knowledge would be useful when friends and family needed phone-a-friend medical advice, but I certainly was not sold on the idea of being a clinician when I entered medical school.

 

Now I am sold- I do want to practice clinical medicine (as well as be involved in research and academics), and I am forever grateful to all the people who have helped me find my way along this path.  My desire to be a fount of knowledge for my friends and family is still one of my greatest drivers, and it is certainly a large part of why I have chosen to pursue family medicine.  I’ve been warned many times that friends and family make the worst patients- they’re notorious for not listening to someone they’ve known since “way back when”. That’s fine- I really am OK with that (just keep your griping to a minimum when your low-fat, low-cal, low-“food” diet fails to leave you feeling great.). I do hope, however, that when my friends do need me, I can live up to the last line of that fantastic poem.

—————–

Oh, and if you’re curious, this is polocrosse.  Check out americanpolocrosse.org for more info. 

Playing this horse (Cripple Gray Zeta) was a privilege and a thrill. Thank you, thank you, Susan and Paul!

Playing this horse (Cripple Gray Zeta) was a privilege and a thrill. Thank you, thank you, Susan and Paul!

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Tomorrow is my last day of medical school.

 

Ok, I don’t actually graduate until December, but as of tomorrow I will have completed all of the requirements for graduation from my school (because of my PhD I am half a year out of sync with the majority of my classmates).  I had initially planned to schedule a few more electives (might as well get as much hands on experience while I am still covered by liability insurance!), but interviews for residency programs have rapidly filled my schedule.

 

In the next couple of months I’ll be travelling around the country interviewing at various residency programs.  Many new doctors restrict themselves to geographic location when they apply to residency (the next phase in medical education- “Graduate Medical Education”), choosing to apply to programs in areas they are familiar with, have connections to, or where they have family.  I am applying widely- generally (though not exclusively) at academic programs, and with little thought to geography.  I’m fortunate to have friends in many of the places I’m applying (I actually think that visiting with friends when I travel to interviews is going to be one of the major perks of interview season), though certainly not all of them (any friends in Rochester Minnesota I’m not aware of?).

 

The “matching” process that graduating medical students (and some who have already graduated) go through seems rather odd to many people outside the medical community.  While I apply to and interview at many programs, ultimately I do not accept or reject a job offer from a residency program.  Medical students and residency programs enter into a system known as “the match”.  Through this process students apply to programs using an online application, programs offer interview invitations to selected students, students interview, and at the end of the day (or February 26th 2014 at 9pm EST if you’re being specific) medical students submit a “rank list” stating their preferences for residency.  Residency programs make similar rank lists, and using an algorithm a computer program determines our fates.  Putting student’s preferences first, the system determines where graduates will be headed for their internship in June or July.

 

March 17, 2014 is the start of “Match week” for my peers and me.  On that Monday we will get an email telling us if we “matched”.  There won’t be any specifics (you don’t find out where you matched until that Friday- “Match Day”), but that Monday marks a day when most med students around the country breathe a massive and collective sigh of relief.  On that day, Facebook is flooded by waves of status updates informing friends and family that “I’ll have a job in July!”, and “I’ll finally be making money” (though arguably not that much as a PGY1 (post graduate year 1).

 

Of course, a small minority of students will get emails that Monday informing them that they have not matched.  In the past these individuals have then “scrambled” for open positions, though now the system has been formalized into a process known as the SOAP (Supplemental Offer and Acceptance Program).  I won’t elaborate, but no student wants to use SOAP.

 

I’ve written before about speed dating for medical students, but then I was talking about the rapid-fire clinical rotations that medical students take in third year.  The interview process is also a “speed dating for medical students” experience, culminating with an arranged marriage of sorts.  While some students opt to do “away rotations” at programs they are very interested in for residency, you can’t possibly do rotations everywhere you hope to interview.  Spending a month at a hospital tells you a lot about the program you would be joining as a resident, but it can be hard to get a real sense of a program in just one day (or half a day, as the case may be).  Some programs offer dinners with residents, or extra time visiting a program, but it is truly a “speed-dating” experience.

 

These “speed dates” are important, since they determine how you choose where you hope to spend at least the next year of your life.  Some new doctors must do a “transition year” before heading off to their specialty of choice, but most new docs are interviewing for positions at hospitals where they will be based for anywhere from 3-7 years (residency training length varies with specialty.).

 

So that’s what I’ll be up to for the next few months- speed dating my way around the country. I’ve been invited to give a talk for the evolutionary medicine program when I’m out interviewing at UCLA, which should be fun, and I’m looking forward to visiting with friends and seeing the sights as I travel around the country.  I’m excited to visit lots of different hospitals and see what different programs have to offer.  Hopefully, when this round of speed dating comes to a close, I’ll have figured out how I want to write my dance card, and hopefully the programs I like find the feelings to be mutual.  If not, I guess there’s always a future in bovine obstetrics!

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It’s been a busy month since my last post.  I’ve studied for and taken the United States Medical Licensing Exams (USMLE) Step 2 CS and (on Friday) USMLE Step 2 CK, two parts of what most people know as “the boards”.  I’ve attended and spoken at the 2013 Ancestral Health Symposium (AHS) and moved out of the apartment I lived in for the last 18 months.  I’m also half way through my “Acting Internship”, a clerkship most medical schools call a Sub-Internship, where I basically function as an intern (a first year medical resident).  I’m doing this rotation at a local community hospital and I’m really enjoying the atmosphere, personnel, and patients.  The hours are long, but not as long as for many of my classmates doing acting internships in Internal Medicine, Surgery, and Ob-Gyn (mine is in Family Medicine, the specialty I am pursuing). Applications for residency programs go live in just over a week which finds me struggling to write (for the fourth time) a personal statement that embodies me

 

Needless to say, things have been hectic , and the last month has been a touch overwhelming at times.  I’m certainly looking forward to some downtime after I finally complete my remaining med school requirements (just 8 more weeks!), have my residency lined up, and am able to catch my breath. 

 

I really shouldn’t complain.  Even in the last, relatively crazy, 6 weeks I’ve still had some good times.  The week of AHS in particular was one for the books.

 

I’ve written before about destinations and journeys.  The destination for AHS was clear- Atlanta Georgia- but the journey I took to get there wasn’t what you might expect. 

 

Many, many, months ago, when the location for AHS was first announced, I made a rather rash statement that Atlanta was almost close enough for a road trip.  While I had no real intention of road tripping to Atlanta, my longtime Twitter friend @PrimalRush (henceforth known as James) said he was keen to tag along for the journey.  At the time I thought an actual road trip was unlikely (it’s a good 13 hour drive and airfare isn’t that expensive), but as the time got closer I realized I would regret turning down the opportunity to create an excellent story (those that know me know all too well that I’m a fan of adventures and stories). 

 

Since I took 4 weeks off from school to prepare for the boards and attend AHS, I was able to take some extra time travelling to AHS.  About a week out, I vaguely mapped a path to Atlanta, made plans to pick up my Canadian travel buddy from the bus stop, and hoped for the best!

 

Three days before we planned to pull into ATL, James and I hit the road with camping gear, a cooler, and a tank of gas.  After making a stop at one of my favorite butchers to fully stock our cooler, we made tracks to Shenandoah National Park in Virginia.  We travelled the length of the park on Skyline Drive, stopping about midway to camp for the night. 

 

At times, we were in the clouds driving on Skyline Drive.  Driving the length of the park added a few extra miles to our trip, and certainly slowed us down a bit (the speed limit is 35mph and you can't help but pull over and ogle at the views), but it is certainly worth it!

At times, we were in the clouds driving on Skyline Drive. Driving the length of the park added a few extra miles to our trip, and certainly slowed us down a bit (the speed limit is 35mph and you can’t help but pull over and ogle at the views), but it was certainly worth it!

 

Without going into detail, our time in Shenandoah involved meeting some mushroomers who confirmed my Chanterelle (and Chicken of the Woods) identification, cooking a truly excellent camp dinner (with Chanterelles), having a run-in with a slightly disgruntled ranger, hiking part of the Appalachian trail in the dark, pitching a tent in the dark, waking up and breaking down camp in the dark, and then scrambling to a 360o viewpoint to watch the sun rise.  When we were finally able to tear ourselves away from our solitude and sunrise we hiked the couple miles back to the car and made tracks through the rest of the park and onto our next destination in Mortimer North Carolina.

 

A delicious addition to our dinner (good thing I had some Kerrygold butter in the cooler!)

A delicious addition to our dinner (good thing I had some Kerrygold butter in the cooler!)

 

I'll take this over dehydrated rice and bean camp dinners any night!

I’ll take this over dehydrated rice and bean camp dinners any night!

 

The view at dawn from Bearfence mountain.

The view at dawn from Bearfence mountain.

 

It was certainly worth waking up at 5, and hiking in the dark, to watch the sun rise over Shenandoah.

It was certainly worth waking up at 5, and hiking in the dark, to watch the sun rise over Shenandoah.

 

How could I resist?

How could I resist?

 

Mortimer North Carolina holds a special place in my heart.  One of my longtime friends has a family cabin in Mortimer, and I’ve twice travelled with her for an escape to the mountains and the beauty of Wilson’s Creek.  Mortimer is also home of Betsey’s Ole Country Store an establishment owned by my friend Bruce.  The address to Betsey’s is a little deceiving- let the record show that “Highway 90” is a gravel road where you need to pull over to let oncoming traffic pass. 

 

Anything I say about Betsey’s or the owner/operator of the establishment, Bruce, would sound like a paid advertisement, so I’m not going to even start.  What I will say is, if you want to visit a beautiful part of North Carolina- visit Mortimer. And if you visit Mortimer- visit Bruce.  He’s got cabin rentals, inner tube rentals, and more knowledge of the area than you’ll find anywhere else.  If you ever find yourself that way, tell him Victoria sent you… Seriously!

 

With Bruce’s back yard as our home base (he is a gracious host), we put in many miles of hiking, had numerous dips in local swimming holes, and managed to spot some of the Perseid meteors.  It was hard to tear ourselves away in order to make it to Atlanta on schedule (we actually didn’t make it to Atlanta on schedule because we opted to take a morning hike before we hit the road).

 

Betsey's. "Peace and Love, Y'all"

Betsey’s. “Peace and Love, Y’all”

 

Putting in some miles in Pisgah National Forest...

Putting in some miles in Pisgah National Forest…

 

I was keen to keep my socks dry, and I did! At least for the first half of the hike (darn slippery rocks)...

I was keen to keep my socks dry, and I did! At least for the first half of the hike (darn slippery rocks)…

 

My new favorite swimming hole, at the top of Gragg Prong fall.

My new favorite swimming hole, at the top of Gragg Prong fall.

 

The reason we didn't make it to Atlanta on schedule- I had to introduce James to one of my favorite spots- Big Lost Cove.

The reason we didn’t make it to Atlanta on schedule- I had to introduce James to one of my favorite spots- Big Lost Cove.

 

It goes without saying that Atlanta was a big change of scenery in comparison to the preceding few days.  I actually didn’t see much of the city, save for the inside of the Sheraton Conference center, a few of the fine dining establishments, and Boyd Eaton’s gorgeous house where the presenters dinner was held.  Prior to the official start of AHS, a number of the Physicians and Ancestral Health docs got together for a brief meeting.  It was great to catch up with these like-minded Docs, and I was reminded, again, how refreshing it is to spend time with people who share passions and interests. 

 

AHS itself was fantastic, save for a few AV snafus. I thoroughly enjoyed some of the plenary talks: namely Nassim Taleb’s antifragile talk, Gad Saad’s talk on The Consuming Instinct, and Geoffrey Miller’s talk on Sexual Fitness (not talking about “reps for time”).  I was a bit surprised by Mel Konner’s and Boyd Eaton’s talk on the history of modern “paleo” diets, where they repeatedly said that our modern diet is much higher in saturated fat and lower in polyunsaturated fat than historic diets… I find it hard to believe that any diet that contains modern vegetable oils has anything other than an excess of polyunsaturated fats. 

 

There were many excellent talks over the course of the conference, and it was often hard to pick which talk to attend out of a very tempting schedule.  I look forward to catching some of the ones I missed online when the videos are posted.  On that note, my talk on Dietary Fats and Fatty Liver Disease, went well.  When the video becomes available I’ll try and post it here!

 

As much as I enjoyed the various lectures, workshops, and posters, the highlight of AHS was catching up with friends and making new ones.  There is quite a vibrant online community of those interested in evolutionary and ancestral health, and AHS can sometimes seem like the interwebz in 3D.  As someone who would happily trade days of online interactions for even brief face-to-face encounters, AHS was a social occasion that refilled my tanks and renewed my enthusiasm. 

 

Back in May, on the Wilderness Medicine elective in Utah, our instructors expressed that one of the goals of the elective was to “stock good memories” for the rough times that were to follow in residency (all but 2 of the 12 students would be starting internship in the next month).  I still have quite a bit of time until I start residency (though the march towards June of 2014 soldiers on), and my goal between now and then is to bank as many good memories as I can.

 

Stashing good memories (and looking for Hobbitses).

Stashing good memories (and looking for Hobbitses).

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OK- enough (for now) of the photo documentation of my past month of explorations!  While I am keen to write more about the environment, wildlife, and general experience of my last month in Utah, it’s time for me to get back to the reality of a med student and think (and write) about medicine.

 

A number of schools (and programs) offer Wilderness Medicine electives for medical students, but I chose (and was fortunate to get a spot in) the elective offered by UMass Medical School.  A few things drew me to this program.  First- it has been running for 20 years, so I initially suspected they were doing something right.  Second- many Wilderness Medicine courses are taught in classrooms with field trips and forays “into the wild” for practical experiences.  The UMass course is taught in the wild. With the exception of our first day of lecture, conducted in a hotel meeting room, all our lectures were done outside on snow, in boats, on beaches, or sitting in the desert.  Thirdly- we got to experience three different environments in the course of three weeks.  A few other courses are taught in the wild, but they are taught in a single environment.  Utah gave us access to three, very different, environments (as shown in my previous posts: alpine, river, and desert).

 

This was our main classroom in the alpine section.  We'd just arrived and are taking a quick break before setting camp, but this area was left open and we would congregate here for lectures.

This was our main classroom in the alpine section. A classmate snapped this shortly after we arrived when we were taking a quick break before setting camp, but this area was left open and we would congregate here for lectures. 

 

When I initially described this course to friends and acquaintances, many suggested that this course was basically Outward Bound for doctors.  The answer, I suppose, is yes and no.  There was certainly a lot of medical learning done in this class, but we also gained life skills that will not only help us in future endeavors in the wild but will also give us confidence as we go forward in our medical careers.  Broadly, it taught us to have confidence in our decisions and to use what we have available to do the best that we can.  I’m unlikely to ever have to improvise a splint in the Emergency Room, but knowing that I can, and having that confidence, will carry me and my classmates a long way as we progress to interns, residents, and one day attending physicians.

 

As you might expect, the medical topics that we covered were married to the environments and activities we were doing.  Before heading out on our first big trek we had a thorough lecture on blister pathophysiology, prevention, and treatment. Once in the alpine, we promptly learned about hypothermia, and how to create a hypowrap to help someone with hypothermia.  We learned about frostbite and non-freezing cold injury, as well as thermal burns, sunburns, and sun blindness.  While in the mountains, we also discussed various problems that occur at high altitude.

 

A lot of injuries in the wild are orthopedic, so we had multiple sessions on splinting, immobilizing, and caring for these injuries.  We also learned various lifts, rolls, and carries, utilizing minimal equipment- since you don’t always have a backboard and a team of people to help you.  Along those lines, we learned just how difficult it is to litter carry someone out of a bad situation (you need about 18 people to go 1 mile, and it will take you a LONG time).

 

It's not what you would do in a hospital setting, but how do you get someone with a potential cervical-spine injury free after you’ve just dug them out of an avalanche slide? Stabilize their neck with their arms and drag them! (And kudos to our instructors.  Not only did they dig a deep snow cave for us to locate with avalanche beacons, but one of the brave residents agreed to be buried down there for one of our “scenarios”. I wish I could have seen the look on my face when we realized there was a person 5 feet under the snow!)

It’s not what you would do in a hospital setting, but how do you get someone with a potential cervical-spine injury free after you’ve dug them out of an avalanche slide? Stabilize their neck with their arms and drag them. (And kudos to our instructors. Not only did they dig a deep snow cave for us to locate with avalanche beacons, but one of the brave residents agreed to be buried down there for one of our “scenarios”. I wish I could have seen the look on our faces when we realized there was a person ~5 feet under the snow!)

 

 

The slope that we dug our patient out of- the instructors made the scenarios very realistic while keeping everyone safe.

The slope that we dug our patient out of- the instructors made the scenarios very realistic while keeping everyone safe.

 

Injuries in every settings... here I’m sporting a mid-humeral splint fashioned out of a camping chair (in the rain and on the river).

Injuries in every settings… here I’m sporting a mid-humeral splint fashioned out of a camping chair (in the rain and on the river).

 

A number of dermatologic conditions occur in the wild, so we discussed their various etiologies.  We also discussed methods of wound management, including wounds caused by snakebites, insect stings, and mammalian injury.  (On that note, during our time in the desert our group spotted rattlesnakes, scorpions, and a black widow spider.)

 

A trio of beasties spotted on our trip.

A trio of beasties spotted on our trip.

 

Many of the topics we covered are much more likely to be encountered in the wilderness than in a clinical setting, but some topics are ever-present in any setting.  Anaphylaxis and allergies can occur at any time, and while you may acquire tick-borne illnesses or infections diarrhea in the wild, the incubation time for many of these mean that they frequently present at a primary care office.  Nonetheless, these were topics we covered on this course, frequently harking back to the “bible” of wilderness medicine: Wilderness Medicine written by Paul Auerbach.

 

Thus far I’ve mainly focused on the didactic portion of the course, but much of the learning took place in “scenarios”.  I’ve never participated in simulation medicine, save for the standardized patients we get on our OSCE (Objective Structured Clinical Exam) at the end of most clerkships. While at first it can be awkward to “practice” medicine on people that you know are acting, once you get into the part it is a wonderful way to learn.

 

The beauty (and perhaps the terror?) of our scenarios was that our instructors would let us “play it out” in the field.  In clinical settings, while students may participate in discussions about patient care, they are never in the driving seat.  In our wilderness scenarios we were allowed to make the decisions and deal with the consequences.  At times this was frustrating (can’t I just ask the Wilderness Fellow standing over my shoulder what I should do), but it also allowed me to make mistakes that will stick with me for years to come.  For example, if a “helpful” stander by hands your patient some food, make sure they’re not allergic to it before they take a bite (that’s how a painful case of sun blindness can progress into life threatening anaphylaxis).

 

The scenarios also allowed (or I should say made) students make decisions about evacuation. Do we evacuate the patient? How? Can they walk? Do they need a litter? Do they need cervical-spine protection? Do we leave now or hunker down for the night and head out tomorrow? What’s the best evacuation route? Could a rescue team get a helicopter in here? A snowmobile? Maybe we should send runners to a ranger station? Where’s the closest location we can get cell phone reception?

 

The scenarios progressed with our wilderness medicine knowledge, as well as our knowledge of Incident Command Structure (ICS).  There were twelve medical students in our class, and when we had a scenario with one patient, it would be easy to have “too many cooks in the kitchen”.  On the other hand, when we had three patients, we could quickly run out of hands as people were relegated to “safety officer”, “equipment”, “communications”, and if the scenario necessitated it “runners” leaving the scene to make contact with civilization.

 

All in all, the medical education side of this course was excellent.  Some of the medicine was a review, but it was a much-needed review and one that frequently found we students (who are trained to practice medicine in well-stocked hospitals with multiple imaging modalities at our fingertips) asking “what do we have that we can use” and “how can we do what we need to get done”.

 

Medically, this class was a reminder of quite how much we’ve learned about medicine in the last few years.  It also emphasized that frequently there is no “right way” to handle a situation and your best guess and best efforts may save the day. We were also reminded of the reality that sometimes there is nothing you can do to save a life… and that is an important lesson to learn as well.

 

 

Not a bad place for a lecture...

Not a bad place for a lecture…

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I have spent only 5 of the last 25 nights in a bed (4 different beds, to be precise). At this point I feel a touch claustrophobic in bathrooms and feeling clean is certainly a novelty.  My Wilderness Medicine elective is over and I have had an exceptional visit in Moab (more on that in another post). Tomorrow I head to the mountains of Colorado for one last stint in the wilderness before heading back to New Jersey where I will start a radiology elective on June 3rd.  From a month in the wilderness to an elective spent in dark, windowless rooms- the change in environment couldn’t get much more extreme (which is saying a lot, coming from someone who has gone from alpine camping to desert camping in the course of 3 weeks).

 

This is the final installment of “Pic of the Day”, at least for the Wilderness Medicine Elective.  I may not be able to resist a “Pic of the Day, Moab edition”… we shall see.

 

For the desert portion of the course we headed to Canyonlands National Park, specifically The Needles District of the park.  We spent 4 nights in 3 different sites, hiking up to 12 miles a day with heavy packs.  I found this portion of the course the most physically demanding, but at the end of the day it was unquestionably my favorite section.

 

I’ll write details in future posts, but for now: Pic of the day- desert edition.

 

Day 1- Canyonlands

 

The geology of Canyonlands (actually, the geology of much of Utah) is stunning and fascinating.  This is in the needles are, near Lost Canyon, where we spent our first night in the park.

The geology of Canyonlands (actually, the geology of much of Utah) is stunning and fascinating. This is in the Needles District, near Lost Canyon, where we spent our first night in the park.

 

Day 2- Perspective

 

Looking back at Lost Canyon as we hike out to Elephant Canyon, our next campsite. From many vantage points in the park you could see the snow capped La Sal Mountains.

Looking back at Lost Canyon as we hike out to Elephant Canyon, our next campsite. From many vantage points in the park you could see the snow capped La Sal Mountains in the distance.

 

Day 3- Druid Arch.

 

Before we packed hiked our big packs out to Chesler Park, we took an early morning park out to Druid Arch.

Before we hiked our big packs out to Chesler Park, we took an early morning hike out to Druid Arch.

 

Day 4- The Joint Trail

 

Probably one of the coolest trails I have every hiked, winding through a narrow slot canyon.

One of the coolest trails I have every hiked, The Joint Trail winds through a narrow slot canyon.

 

 

Day 5- Sunrise and out.

 

We left camp at 4am for the 3+ hour hike out.  I led the group of 19 by head lantern for 2 hours before stopping on a bluff to watch the sun rise around 6am.  Pre-dawn hikes are something I will be adding to my repertoire.

We left camp at 4am for the 3+ hour hike out. I led the group of 19 by head lamp for 2 hours before stopping on a bluff to watch the sun rise around 6am. Pre-dawn hikes are something I will be adding to my repertoire.

 

I did not expect to fall in love on this trip, but I have certainly fallen in love with the desert.  I don’t know when I’ll be back, but I hope it is soon…

 

Chesler Park.

 

Chesler Park

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