LEADING A DOUBLE LIFE_006

Leading A Double Life

LEADING A DOUBLE LIFE__EPISODE 006 Trials of a doctor-in-training—Part 1 Hi, everyone, and welcome to episode 6 of my podcast Leading A Double Life. I’m Kwei Quartey, a physician and author of the Inspector Darko Dawson novels. On my podcast, what it’s like to be a medical doctor and a writer. This episode, Trials Of A Doctor-In-Training, Part 1 In medical school, there are certain main subject categories like Anatomy, Physiology, Biochemistry, Pharmacology, Pathology, and so on. A med student has to study a lot, although there isn’t as much dry reading as there is in law school, for example. In case law, you might read a case Mr. X versus the State that is page after page of long, wordy paragraphs. In medicine, cases might have images to support clinical situations and break up the tedium. In neurology, for instance, you have diagrams of neural pathways that you must learn in order to understand a particular neurological disorder. It makes understanding the pathology easier, although it doesn’t necessarily give you less to memorize. In histopathology, a student is tested on the human tissues and different types of cells seen under a microscope. One of the most intimidating types of exams is when you’re given a certain amount of time, say 30 seconds, to identify a human cell type, and you must move onto the next station when the examiner rings the buzzer. Falling behind in writing down your answers can be a catastrophic domino effect. Among the subjects medical students have the most anxiety about, Anatomy is probably the mother of them all. It’s the study of the structure of bodily parts and their physical relation to each other, and the study of human anatomy traditionally involves dissection of the human body much the way many of us dissected frogs or mice in high school or college. For most freshmen and fresh-women in medical school, human anatomy is the first time to see and experience a dead body. I remember I was a little apprehensive about what it would be like, but I recall some other students who were almost paralyzed with anxiety. I remember the dissection hall as a large room with two long rows of stainless steel tables upon each of which was a male or female cadaver. My reaction to the bodies was surprisingly muted. They had an unreal, waxy, Madame Tussauds appearance. The skin texture was nothing like a live human. They reeked of the formaldehyde preservative, and sometimes it was so strong as to make my eyes water. In the end, I think even the students who were most worried about the cadavers got used to the idea pretty quickly, and two or three weeks in, no one batted an eye. Each student is usually assigned to a pod of 7 to 10 colleagues who stay together as a group with the same cadaver for the duration of the semester. Each pod follows the syllabus under supervision by a medical fellow, that is, a junior physician specializing in the field. The study of the cadaver’s anatomy follows major regions or systems of the body: head and neck, upper limbs, chest, abdomen and so on. But within each of those are subdivisions: for example, the head and neck will include the lymphatic, neurological and muscular systems. Whether you get a male or a female cadaver is luck of the draw, as is the amount of adipose tissue your cadaver has. Consider yourself lucky if you have a lean body. They are much easier to work with. I know of one medical school that traditionally has the staff and students hold a moment of respectful silence before the first cuts on the cadavers are ever made. They were once living human beings, and in a way they have sacrificed their bodies to us for the sake or our learning from them. I think that moment of silence is a wonderful gesture, and I wish my medical school had done that as well. Now, working in groups like our Anatomy pods is not always easy. One medical student often turns out to be something of a leader within the pod, but there can be friction between strong personalities. Sometimes you can feel intimidated by someone who always seems to know a lot more than you, or seems able to grasp the anatomy more quickly than you do. I always felt like I didn’t want to hold back the group if I didn’t get something, and preferred to ask another student or one of the supervisors after class. The problem with that is it’s always best to ask one’s questions in real time, and not after the fact. The amount of material to learn, absorb and memorize in Anatomy is staggering. A student needs to know where every nerve begins and ends, which muscles the nerve controls, the origin of every skeletal muscle and the bone on which it ends, and so on. Remember that there are something like 650 skeletal muscles in the human body. All of this information can become overwhelming, and the practical exams in which you’re faced with an unidentified organ, muscle or bone are nerve wracking. For all these reasons, Anatomy is almost certainly one of the most stressful subjects in the medical school years, but it can be also enjoyable. Most of the anatomical knowledge the medical student gains in Anatomy will stay with him or her throughout his or her life as a practicing doctor, and for those who go into surgery of any kind, whether it’s general surgery, orthopedics or neurosurgery, Anatomy is of the highest necessity. The name of the TV series “Grey’s Anatomy” originates from the all-time classic textbook, Gray’s Anatomy by British surgeon Henry Gray, with its iconic illustrations by Henry Vandyke Carter. Dr. Gray was born in 1827 and died of smallpox in 1861 at the tragically young age of 34. His 750-page textbook, first published in 1858, is highly acclaimed to this day for its masterful descriptive detail accompanied by some 365 extraordinary diagrams. The TV program spells “Grey” with an “e,” while the textbook “Gray” is with an “a.” The 41st edition, the latest, was published in 2017. Modern versions of the textbook connect anatomy more with clinical scenarios than the old editions. By the way, I’ve never seen an episode of “Grey’s Anatomy,” but I have used the textbook! If Anatomy is all about the structure of bodily parts, then Physiology is the function from the macro to the micro level. We can analyze how a person’s leg works by describing how the muscles contract, but inside the muscles are a collection of microscopic actin and myosin fibers that work together to create the muscle contraction, and within each fiber, certain chemical, electrical and neurological actions take place at the cellular level to bring about the desired effect. Although Anatomy is a superpower in the study of medicine, I probably enjoyed Physiology a bit more because it took less hard memorization and more understanding of process. Pharmacology and Biochemistry had the least appeal of them all. Which subject you love is a combination of your personal interests, abilities and background, as well as how good your teacher is and how much you like him or her. In med school, I noticed different study patterns among students. Some liked studying in pairs, others in groups, and those like me preferred studying alone. I often wished I could learn in a group setting because theoretically one should be able to benefit from exchange of knowledge, but I always found interjections from others in the group distracting, as if I kept getting knocked off a path I was trying to follow. Much later in my career—in fact after medical school—I realized that for me, the most effective way of studying for exams was to do as many practice questions as I could get my hands on, and that’s the way I study now if I need to take any tests for continuing medical education and so on. Just as in other fields like astronomy or engineering, the volume of knowledge and information in medicine seems to have increased several fold over the past decades, and has the way that knowledge is shared has also changed. In my next podcast, I’ll talk about how learning has evolved with the advent of a pocket-size device that can hold a lot more textbooks than you can lug around under your arm: your smartphone. That’s all for this episode. Again, thank you for listening. If you’re hearing this on iTunes, please also check out my website, kweiquartey.com. That’s k-w-e-i-q-u-a-r-t-e-y dot com. There’s a sign-up bonus, so to speak, right now. If you subscribe to my email list, you win a beautiful Page Anchor exclusively and directly from the lovely nation of Sweden. It’s a uniquely designed device that holds your pages open for you. The podcast episodes are also available on my website with accompanying show notes. I’m on Twitter as @doublekwei, one word. Until next time, be happy and healthy.