A taste of practical medicine

"The student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end." -- Sir William Osler, Aequanimitas, 1905

I've been doing a little practical medicine the last few days. Before I get ahead of myself, I didn't perform surgery nor cure anyone of cancer; however, I did learn to suture, join the newly forming oncology club and educate local Dominican women about breast cancer and cervical cancer.

First on Thursday, AMSA (American Medical Student Association--which is part of the American Medical Association) held a suture clinic for it's members (we learned discontinuous stitches). We took over the anatomy lab. There were slabs of flesh--I know it sounds disgusting, but do you really want a medical student to practice sutures on a living person? I think slabs of cadaver flesh are a much better idea. We had a rounded needle (people said it was similar to some type of fishing hook) forceps (tweezers with grips) and a needle holder (actually we used a hemostat, which resembles a set of scissors with a locking clamp replacing the blade, since it is used for dissecting/surgery and most of us have them for anatomy class). One of our professors, who is a surgeon, led the suture clinic and taught us the discontinuous suture technique. She is such a prim and proper lady, who always looks so put together; I, on the other hand, had my hair in a knot on the top of my head and was in scrubs while clumsily, working with my needle.

You have to clamp the needle into the needle holder, which is much harder than it sounds as you must clamp a particular location and it must be at a 90 degree angle to the needle. You must get this just right so that the curvature of the needle will be at the correct angle so that you can poke through the skin, not going too deep, then poke out at the right spot. You need to be about 1 cm from the incision (at least for the type of suture we learned) and you need to have the tension of the stitch just right (or you get edema--fluid build up in the tissue spaces). As if that isn't hard enough, you have to do several other clumsy things: you must release the needle, wrap the free end of the string around the hemostat three time (clockwise), grab the free end of the string with the hemostat while grabbing the needle with the forceps then pull everything (but not too tight). You then have to do this two or six more times and each time you must switch the way you wrap the string: counter clock wise or clockwise. THEN you have to make sure that the knot is on the same side of the cut so that it looks nice (I think there maybe a medical reason why they must be on the same side, but I don't know for sure). Since we learned discontinuous stitches, we had to knot off every stitch. Suturing is such an art--I can't imagine being a surgeon. The professor teaching the clinic came and critiqued our stitches. To my dismay, my stitches were "a little loose, but beautiful technique." She even said that she would let me put a few discontinuous stitches in a patient--what a compliment!! I was awkward and very slow, but I think it was easier than learning to knit. If I had a chicken breast and a few hours, I could massively improve my suturing skills.

On Friday, another exciting thing happened: the inaugural meeting of the Oncology Club. I can barely stand myself. I just love oncology, which probably sounds very strange, but I think it is about the most intellectually interesting thing imaginable. How the body grows out of control and how the body tries to compensate is so interesting. I also think the treatments are incredibly interesting--oncologist try to kill the cancer and also inadvertently kill the health cells. Management of the side effects of chemotherapy in and of itself is complicated without getting into the surgical, radiological, and psycho-social aspects of cancer treatment. Needless to say, I joined the newly formed Oncology Club.

On Saturday, Farley and I participated in an AMSA sponsored Women's Health Fair. The clinic was on the street corner near the market form 7:00 until 12:00. Farley took blood pressure and I educated women about breast exams and HPV/ cervical cancer (HPV = Human Papillomaviruses). The women were very open to learning about monthly breast exams and practicing their techniques on the dummy (who had two lumps). In fact, some of the women decided to do a breast exam in the street so they could go see the doctor, who was at the clinic, if they found anything. Now, given that they would do a breast exam in the street, it might be a shock that NONE of them let me talk to them about cervical cancer. They ran away so fast, I couldn't even tell them to get their yearly pap-smears, After working at the Health District in HIV/AIDS and Reproductive health, very little embarrasses me; however, I can understand how talking about sexually transmitted infections on the street corner (with men all around) could be very uncomfortable. I think they would have been interested in the information in another format.

Here is another picture of beautiful Dominica: