My preceptor has assigned me plenty of reads to enhance my experience as a student-nutritionist this summer. Without getting into specific details about the clinic I work at, I can say that a large portion of our patients are refugees, immigrants, or both. I have been enriched by various cultural experiences right with my own patients. This book was extremely fitting.
The Spirit Catches You and You Fall Down is a story about a Hmong family who immigrated to the United States in the 1980s. The large family settled in Merced, California among other Hmong families. The Lee family had a healthy daughter named Lia who later developed a seizure disorder when she was 3 months old. This story describes the challenges with a language barrier, and not only that, but the lack of similar terminology across different languages. During certain parts, when Lia was brought to the emergency department, I couldn’t stop reading.
If you plan on going into medicine, nursing, pharmacy, or any other allied healthcare profession, READ THIS STORY.
In the United States, we nearly unanimously agree with modern medicine and our healthcare system. When you go to an ER, you expect to wait. You trust the physicians to diagnose you based on how they examine you, what your scan looks like, and how your labs come back. We believe and trust our doctors, and if we don’t, we can get a second opinion. What if something goes horribly wrong in our care? A misdiagnosis that leads to mistreatment? We have options. But if those things cannot be communicated, much less understood, would you feel safe trusting these professionals?
This story is a reminder of perspective and that our system in the US is simply one way of tackling the healing process. That’s all it comes down to; wanting the best for our patients and their families and making them feel better. That’s why we choose medicine. If you choose to read this story, which I highly encourage, you will learn so much about the US medical system, you will learn about the Hmong culture, and you will learn to be more culturally sensitive. Find it here.
The name of the book sounds…scary. And as we all know, the food industry in the United States can be rather that way. You are probably aware that obesity rates are increasing and not showing any signs of letting up, in fact, it continues to increase over time. You probably know that sugar is “bad,” and high fructose corn syrup is even worse as far as long term health consequences go. You have probably been told that burgers should not be a staple of your diet. But what SHOULD you eat? Read this one to find out. You’ll find that it’s a lot more simple than you’d think!
Dr. Furhman, a family medicine-trained medical doctor takes the current research behind diet and nutrition and applies it on a smaller scale. He also takes American history and gives insight as to how some of the deprivation we face has started – something I had hardly thought of previously. And not only does Dr. Fuhrman take the historical context of our country, he discusses the current socioeconomic disparities throughout the US; part of which is to blame for our current SAD (Standard American Diet). My nutrition program focuses on health disparities and working on solutions to these problems, so his aim resonated with me and what I hope to become as a future physician.
Dr. Fuhrman also discusses food additives, preservatives, saturated fat, ketogenic (or high-protein, low carb) diets, epigenetics and genomics, eating intact grains and how to cook them, and some of the psychological effects of food. He does a great job decoding some of the daunting terms and explains them in a way that the non-scientist can understand. Each time I read a book written by either a physician or a nutrition professional regarding nutrition, I am inspired and enriched by their knowledge and passion to change the food industry, and help other live healthier and more purposeful lives.
The best part about this book is that I found it at a closing bookstore (sad, yes), and it was 75% off !!!!!! I do not remember how much I paid for it, but if you desire to read this one, which I strongly recommend, you can find it on Amazon for about $16. 🙂 Click here for Dr. Fuhrman’s website, and find him on Instagram. ALSO, Dr. Fuhrman has written several books that have caught my eye… Don’t be too surprised if you catch me reading those too. 😀
A morning with an on-call cardiologist can be as variable and exciting as the days the emergency department has graciously prepared me for. Here’s how I spent my morning:
I started the day chatting with Dr. G’s nurse about the schedule, procedures, and variability in patient cases in cardiology. After Dr. G, an interventional cardiologist, had finished rounding for the morning, I joined him to see his first and only clinic patient of the day. The individual had a new onset of shoulder pain when beginning a new exercise regimen, and after both a negative EKG and stress test, was cleared. Dr. G did an exceptional job of explaining everything to his patient, reaffirmed by the genuine “thank you” and kind words he received. This was an excellent reminder of the clinician I aspire to be.
After finishing up with the sole clinic patient of the day, Dr. G and I headed to the cardiac catheterization (cath) lab. Dr. G was on call, but simultaneously had two scheduled angiograms to rule out occlusions.
The first procedure, I observed from the station with the cath lab techs and nurses who explained the procedure to me. I quickly realized how brief the procedure was (only about 15 minutes start to finish), and then reviewed the pictures with Dr. G. It was negative, but very interesting to watch the contrast flowing through the coronary arteries!
The second procedure, another angiogram, Dr. G invited me in the cath lab. I donned surgical scrubs, gowned and gloved (and masked), and wore lead to prevent radiation exposure. This time, I was able to see Dr. G thread the radial artery and inject dye through and into the heart. Unlike the previous angiogram I saw, there was notable blockage and Dr. G concluded that the patient would need either triple or quadruple bypass surgery rather than cardiac stents.
The photo depicts an image similar to what I had seen on the left.
After talking to Dr. G about conscious sedation, he explained that he uses Versed and fentanyl and only the smallest amounts to start, because it isn’t necessary to completely sedate the patients during the procedure. He explained that he can always increase the dosage if the patient is uncomfortable.
Lastly, Dr. G got a page from the internal medicine doctor for a patient on the floor. This too, presented a learning opportunity for me – I listened to abnormal breath sounds and heard a heart murmur for the first time.
A few things that drew me in:
the opportunity to educate patients about their health and how to make lifestyle changes.
the near-instantaneously relief that interventional cardiology provides in such a small, minimally invasive procedures.
the high-acuity and helping sick, sick individuals recover.
Interventional cardiology is more reactive rather than proactive.
Educating the patient is probably the most effective way to not only achieve greater patient satisfaction, but will also increase the probability that the patient will be motivated to make changes.
The correlation between heart disease and diabetes is notably strong.
Shadowing physicians and being in the hospital, especially at the beginning of a long semester reminds me why I still choose medicine every day. The opportunity to spend an entire day with the gift of having the ability to improve someone’s quality of life sounds like a career I still hope to have.
For my guide to having a positive shadowing experience in the hospital yourself, click here!
My friend over at @heardtohealed on Instagram, Stephen Groner, has combined his experiences of being an ENT patient, and having a career in speech-language pathology and wrote a book full of simple ways for you and I to improve our interactions with patients – making our jobs more enjoyable, and our patients’ satisfaction greater!
Stephen breaks down bedside manner into three chapters:
Starting: Impressive First Impressions
Listening: Giving Them the Mic
Talking: What to Say and How to Say It
In my clinical experience so far, I have found that it can be challenging to relate to patients, relay information, and rationalize a scenario with a patient or their family when they are angry, frustrated, or feeling other hard-to-cope-with emotions. Though these situations tend to get easier the more one experiences them, it remains difficult to know if you are doing or saying the “right thing.” According to Stephen, you’ll learn that sometimes silence is better, and a gesture means more than finding the right thing to say.
Read this book, a quick read (under 70 pages), and reference it when you want to refresh your approachability and success with your patients and your interactions with them. Find it in ebook form here for only $7! I am so glad I read this book, not only for how I can work on the dynamic I have with my current emergency department patients, but also with skills I hope to integrate in my future practice as a physician!
Happy reading! And while you’re at it, go check out Stephen’s page for inspiration and humility!
Just a few short days ago, I asked the surgery residents at work if I could put on a cap and mask on and shadow a sterile procedure in our department. I quickly made myself a fly on the wall and remained out of their way.
One of the residents then asked, since I was in the room, to help hold the patient’s arm out of the way of the procedure underneath the sterile field so her arm would not tire and get in the way. I was a very minimal part of this procedure overall, but the role I held came with standing in the same position for over 30 minutes, and included holding the weight of the patient’s arm up.
I now have even more respect for surgeons who perform lengthy operations and endure gruesome shifts. I am also extremely grateful for the opportunity to have a job that allows me to experience these types of things. Not many people get to go to work and help with sterile procedures every day. It is a privilege to say the least!
But what does this have to do with sweat?
Why do I hit the gym? Well, let me tell you!
1. Stress relief. Feeling good. Endorphins.
Having a busy lifestyle requires some form of stress relief. Lifting weights or hitting tennis balls gives me a a sense of clarity and helps me focus on the tasks I have to complete after I’ve gotten a good workout in. It’s been proven to facilitate good overall mental health and stress relief. If this alone was the only reason, I’d still be exercising.
2. Leading by example.
When we tell our patients to make lifestyle changes such as diet and exercise, we better be doing those things ourselves. I want to be the physician that can help guide patients with proper lifestyle habits by doing them myself.
3. I want to play with my grandchildren.
Whoa. That is a bold and profound statement. Not only does exercise increase longevity, but it improves quality of life. There are chronic diseases that have a strong autoimmune component to them (such as arthritis), but many other well-known chronic diseases such as diabetes, heart disease, and obesity can be prevented with lifestyle medicine.
4. Lastly, to do my job and my future career.
Helping the surgeons reminded me again, I don’t have trouble doing the physical component of my job. Being physically fit helps me to better help transport my patients without worrying about not being strong enough. It helps me make it from point A to point B with ease in an emergency scenario.
It helps me help others and that’s exactly what I hope to keep doing throughout my current job and future career.
Think about this: why do you work out? And if you don’t, why should you?
The emergency room will always have a special place in my heart.
Regardless of anything I have personally experienced, it is well know that the ED is its own entity; its own unique branch of medicine that is nothing like the other areas of the hospital.
We see people at their very worse, sometimes grasping by straws for a chance at survival, and others, aren’t as patient with the wait time. There are sprains, strains, fractures, and lacerations all day, critically ill stroke codes, STEMIs, and traumas all night – well, not necessarily in that order. The department doesn’t sleep and any emergency personnel can tell you a plethora of stories that you might think are too bizarre to be true, but trust us, they are not!
This is best illustrated in the story by Dr. Paul Austin in Something For the Pain: Compassion & Burnout in the ER.
With my continuing experience in the emergency department, I enjoyed reading the struggles and triumphs Dr. Austin faces as an attending emergency medicine physician.
Dr. Austin discusses specific cases he has faced throughout his career and training, but not only that, he talks about how these patients and their stories affect him as a person and his family overall.
Having a career in emergency medicine is a high-stress at high stakes career. Dr. Austin describes how this career nearly ruined his family. It is a reminder that medicine is a rewarding, yet demanding career that proves that if you do not feel that you are taking care of yourself, you will not be best-fit to take care of others in what may be their most desperate times of need.
Read this one to gain insight into life from the trauma bay, the stories on night shift, the forbidden “S” and “Q” words in the emergency department, and the selfless side of medicine that the doctor taking care of you faces each night they try and sleep.
Dr. Austin’s website describes his book more and will give you a preview of his second book.
If you are planning on going into a medical professional field and your school offers histology for undergrads, I highly encourage you to take it. The content is dense, but I believe it is a great preparatory course for several professional programs. I am happy to share with you a few tips that helped me with the course!
First off, let me explain. Histology, broken down, is the study of tissue. (hist/o = tissue, -ology = the study of). As many of us know, our tissues make up our organs. Studying histology allows us to understand the anatomy + physiology of our bodies better from a microscopic perspective. Learning how different cell types, fibers, and structural units that make up each structural element of the body is remarkable and a privilege!
Here is how I can help!
Learn the terminology.
I can’t reiterate the importance of knowing WHAT you’re talking about enough. Knowing the difference between what endothelium & epithelium are may help you with a test question. Endothelium (endo- = inside) lines the inside of the blood vessels and has very diverse properties. Epithelium (epi- = above), is the usually the outermost layer of surfaces such as skin, glands, and lines ducts. What do reticular fibers do? Reticular means “to form a net” and that’s exactly what these fibers do. Reticular fibers form a meshwork for migration of immune cells throughout organs. What about looking at cancers? An ADENOcarcinoma is a glandular cancer. (aden/o = gland, carc/o = epithelial origin, -oma = tumor). When seeing abnormal tissue that is attempting for form glands, you’ll know instantly it is an adenocarcinoma.
2. Know your stains.
The most basic stain (ok, maybe I shouldn’t use the term basic in this case), is H & E – hemotoxylin/eosin staining. That’s the stain that makes everything look purple/bluish. Knowing what stains darker and what stains lighter, or what stains with special stains will help you to determine what you’re looking at.
PAS – stains PINK/MAGENTA; stains carbohydrate (specifically glycogen).
Nissl staining – stains RER (nissl bodies in the nervous system).
Reticulin – stains highlights reticular fibers in the bone marrow.
If you know what you’re looking for, and what stain is attracted to chemically, it will make the process much more understandable.
3. Learn the cell types.
The digestive tract is full of different kinds of cells that are fundamental in the role of the organ. The stomach has chief cells, parietal cells, enteroendocrine cells among others. What do each of these things do? Where are they located? What do they secrete? What do they look like?
For example, parietal cells are “fried egg cells” with a small, centered nucleus, abundant cytoplasm, bubbly appearance, and are found in the gastric glands of the stomach. They secrete HCl, or stomach acid.
4. Look for landmarks.
How do you know you’re looking at the gallbladder? What is distinct about the appendix? Where are the smallest, primordial follicles in the ovary? Finding distinct features about each organ will help you to determine what you’re looking at if you aren’t sure from 40x or more.
The gallbladder is highly folded with no submucosa.
The appendix is a muscular tube rich in GALT, or gut-associated lymphatic tissue. What is the cause of appendicitis? Why are appendectomies the medical solution? Think about it in relation to this slide!
The primordial, or most immature follicles are found around the ovarian cortex. They are smallest in size. As the follicles mature and get bigger, they also move inwards closer to the middle of the medulla of the ovary.
5. Use available online resources.
Below are links to the websites I have used to help prepare me for lab practicals. There are plenty out there, but these were the most helpful to me.
Histology Guide – a virtual slide box with zoom capabilities, labeled diagrams, and thorough explanations. Helpful to view slides from lab at home on the computer.
Histology World – quiz resources, lecture outlines, and more slide images. Practical quizzes that help prepare for lab exams.
I wish you all the best of luck in your studies, and I hope you learn to love histology as much as I did. It’s truly beautiful. As you learn it, this branch of biology, you will probably find yourself admiring the stain colors, and the seemingly-minute details of the human body.
PS: if you’re interested, read about my experience shadowing in PATH after I finished the semester of histology – something I recommend 😀
Nissl staining: New York University Medicine
Parietal cells: Austin Peay State University
Gallbladder: John’s Hopkins School of Medicine
Appendix: Concordia College, Moorhead
Ovary: University of South Wales
Header image is my own: taken at the University of North Dakota. Shows the corneal endothelium/iris junction.