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A Second Year’s Second Semester

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It’s already February and there are only four more units (behavioral sciences, women’s health, musculoskeletal, and nervous system) before one of the most important tests of my life, the USMLE Step 1. The USMLE Step 1 is an eight-hour exam made up of seven 46-question sections for a total of 322 multiple choice questions. In a way, it is a little daunting that the test will gauge my foundation of basic sciences knowledge and the resulting score will be the gatekeeper for different residency programs and the more competitive specialties. At the same time, by finishing and passing this exam, I am able to move onto my clinical rotations and see patients on a daily basis, which I have been looking forward to since starting medical school.

Although I have known about the exam since the beginning of my first year, it has always been something that I had put away in the back of my brain, cataloged for the near distant future. With only four months until my test date, the exam has definitely been on the forefront of my mind, in addition to my classmates’ collective thoughts. Everyone has been talking about it, worrying and stressing about it, or some combination of the two modes. For me, I have been focused on getting prepared and finding ways to avoid burnout, though, I definitely worry/stress/talk about Step 1 in between! I have already registered for the exam and purchased a few of the resources, from board review books to practice question banks. I plan on using these resources throughout the spring semester and during my summer crunch month, which is the dedicated study time that my school gives to prepare for the exam. Moreover, I will be meeting with Dr. Linda Costanzo, the Step 1 guru at my school, to devise an effective study plan for crunch month.

Most importantly, I have been working on figuring out a routine that fits my schedule and gives me the balance that I need, instead of wasting time on being afraid of the exam. For most of second year, I have pondered too long on the what ifs. What if I don’t remember first year material? What if I don’t pass? What if I don’t have enough time? I know that this exam will test more than my knowledge; it will test my perseverance and mental well-being to withstand eight, non-stop hours of test-taking. By following my study plan and trusting myself, I aim to overcome my irrational fears and do the best that I can do on this one exam.

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The Subtleties of Medicine

They say medicine is a hard science, based on heavily scrutinized theories and proven postulates.  Medicine is supposedly made up of differentials, diagnostic workups, and medications aimed to alleviate or cure.  Everything is based on evidence, everything. But, today, something happened that hasn’t been researched using IRBs; something intangible that restored my faith in humanity.

I was on my way home from a long day of being intensely questioned by residents and attendings, and the tiring hustle of being on rotations. It was a long day, but fortunately, I’m a firm believer in that ‘break your neck to keep your head up, if that’s what it takes’ ideology. On my way home, I was stuck in traffic for over a half hour.  As I inched up at a snail’s pace, I notice that there was a car broken down in the middle of the road. Cars would pass, but no one would offer help.  When I looked in the car, I saw a brittle, old woman complete with an osteoporotic kyphosis and walking shoes, and I immediately felt a primal need to help.

I got out of the car, garbed in a shirt and a loosened tie, remnants of my long day in the hospital.  I ran up to her window, plainly stated my intentions, and got behind her car to get to work.  Cars passed, and no one would let me push her to the side of the road.  Then, like a scene from a movie, a man got out of his car, and wordlessly started helping me push.  Before I could blink, a truck pulled up and blocked the two lanes of traffic, not allowing anyone to pass.  At the same exact time, a third man got out and ran to help with the car.  Together, we pushed the car to the side in less than 15 seconds, and traffic was able to run smooth again.   When I ran up to her window to ask her if she needed anything else, I saw that twinkle that builds up in your eyes right before you cry, and with the sincerest words I’ve ever heard uttered from a stranger, she said, “I love you.” I was taken aback, and felt my eyes well up with tears as I walked back to my car.

The thought of what occurred gave me the chills on the rest of my way home. Four strangers got together to help this old woman get off the road safely.  We worked without words, like a machine. We worked quickly and efficiently – like brothers – all without even making eye contact.

What occurred today is what medicine feels like. It’s not hard science. It’s not protein transcription, chest CTs, and pre-operative clearance. It’s not stethoscopes, big words, or fancy $3,000 medications.  Medicine is healing. And it can be done with words, actions, or a smile.

Those men made my day better. And together, we made her day better. And I don’t even know their names.

That’s medicine.

Edwin Headshot

Edwin Acevedo, Jr. is a first-generation college graduate from Passaic, New Jersey. He is the son of hardworking Puerto Rican parents, who strongly emphasized the value of an education, and pushed Edwin to become the best student that he could possibly be.

Edwin graduated Cum Laude from Rutgers University in 2011, with concentrations in biological sciences, public health, and psychology. He is currently a third year medical student at Robert Wood Johnson Medical School where, among numerous other activities, he serves in leadership roles for the Student National Medical Association (SNMA) and SALUD, an organization associated with the Latino Student Medical Association (LMSA).

He is devoted to his family and his girlfriend of 6 years, and knows that none of his successes would have been possible without their continued support and encouragement.

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Reflection Outside the Classroom

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Photo Credit: Wikipedia

I spent Thanksgiving evening on the floor of my mother’s one bedroom apartment, carving out pieces of turkey seasoned like chicken masala while swirling endless amounts of whip cream on home baked pumpkin pie. Amidst the gnawing and munching, bursts of roars would erupt as we became increasingly competitive in the ongoing game of ludo (South Asian version of Parcheesi). I was surrounded by old and new family, with a broad grin plastered on my face.

There was so much to be grateful for.

I know that I will be returning to class this coming week with a rejuvenated soul. These past weeks had become gradually more and more burdensome as I struggled to get through the drudgery of medical school work while losing focus of my initial intentions for entering the profession. Feeling demotivated, I was falling further and further behind.

My college education had strengthened what life experiences and my mom had already instilled in me – the need to dedicate my life to redressing social injustices. As a Women’s & Gender Studies major, I immersed myself in feminist scholarship and embarked on a journey of questioning and dismantling all paradigms I had assumed to be fundamental truths. One of these paradigms entailed the perception that a lack of social mobility for some communities existed solely due to an inadequate work ethic. It was such a naive conclusion that was fed to me as far back as I can remember – with U.S. history teachers clamoring about the greatness of my nation being based on the principle of “pulling yourself by the bootstraps.” However, my last four years were spent in an environment with highly encouraging professors and like-minded peers who all recognized that with privilege (such as an Ivy League education) comes the responsibility to engage in civic work. Engagement with communities that avoids any elements of self-aggrandizement or co-optation was an ideal I sought to continuously strive for moving forward in my career.

Perhaps it was the abrupt departure from this academic bubble to enter another environment with different priorities that had left me feeling disoriented. Instead of analyzing strategies used by grassroots movements or critiquing problematic aspects of economic development proposals that dehumanizes the indigenous communities, I was now spending hours poring over reactions or physiological reductions of human disease. Granted, this knowledge is crucial for my career and becoming capable of providing treatment to my patients,  andmy medical school does do an incredible job of periodically bringing back focus onto the humanistic part of medicine.

The physician-patient relationship is hailed as a sacred and involves  great ethical and responsible behavior. We are all encouraged to incorporate a “patient-centered” section as an integral part of our medical interviews, as a means of letting patients speak for themselves without expanding the intrinsic power dynamic that exists between the physician and patient. We’ve taken classes on the significance of psychosocial factors on the manifestation of various symptoms and we, in turn, have been expected to appropriately address them in our interviews with standardized patients, and now real patients, through the preclinical clerkship. My clerkship sessions are held at the VA hospital and every week I walk away in awe of the great degree of intimacy that can be established between me and the patient in front of me solely due to the white coat I have begun to wear.

What was then missing you may ask?

My medical school places an undeniable emphasis on “hard-science” research and highly specialized medicine. This emphasis is clear in interactions with faculty and shadowing opportunities that are available for pre-clinical students. My goal has been and still is to work on health disparities, with a growing interest in areas such as clinical interventions for trauma. I have been fortunate to finally form bonds with peers with similar passions as mine and to receive much needed advice from the less visible faculty members here who insist that there is a great and increasingly needed space for community based research in medicine.

So while my motivations for entering a career in medicine are not immediately being met at the moment due to a lack of ongoing research projects or physician mentors in the areas I am interest in, I feel reenergized to keep searching. I am incredibly grateful for being in the position I am in right now and am going to maintain a strong grasp of my overall vision. A vision in which marginalization of identities, experiences, and backgrounds no longer prevents a fundamental human right to good health is what will continue to sustain me as I tread forward in my medical education. Briefly stepping back from the daily toils of being a student during Thanksgiving reinforced the need for me to engage in moments of personal self-reflection in order to preserve my initial intentions of becoming a compassionate agent of change for health justice work.

About Tehreem Rehman

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Tehreem Rehman is a first year student at Yale School of Medicine.  She recently graduated from Columbia College as a John Jay Scholar with a B.A. in Women’s & Gender Studies. As a Co-Founder of Columbia’s Public Service Initiative, Tehreem was selected to be a People for the American Way Foundation’s Young People For (YP4) Fellow for the 2012-2013 academic year in order to expand the program. Tehreem has previously served as the National Chair of the American Medical Student Association’s Race, Ethnicity, and Culture in Health committee and as a National Editorial Advisor for the New Physician Magazine. She is currently a Humanity in Action Fellow through which she intends to create a multi-school platform to address institutionalized racism and sexism in the medical school admissions process. Tehreem is interested in clinical interventions for violence, addressing gender power dynamics in the clinical setting, and the impact that health inequities have on women of color and low-income backgrounds.

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I Am Just A Medical Student

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She’s well into middle age*, but appears just days older than 40. Her eyes are sunken, tearful, worried, anxious. She tells me about her grandchildren, and how she just visited them out west. She came to the hospital straight from the airport. She’s worried.

She’s worried because her shortness of breath hasn’t gone away for over a month now. She has had breast cancer, and opted for a more conservative approach – a lumpectomy with axillary node biopsy without radiation. She’s admitted, and gets a chest x-ray and a CT scan, which show a pleural effusion [excess fluid in the lungs] with what looks like nodules in both lungs. ‘Likely represents metastatic disease,’ [the spread of cancer from one organ or part to another non-adjacent organ or part] reads the official radiology report. She has already been told, so I don’t bring it up again.

I am just a medical student, I think.

On the second day, she undergoes surgery to evacuate the effusion, and her lung is biopsied. Now, we wait for the pathology report. I visit her every day as we wait for the biopsy report to come back, sometimes two or three times. I’ve met her husband, and we know each other by our first names. Her children are beautiful people, just like her. They ask me questions, and I keep my answers limited to what I’ve read in the chart. They never ask me about the cancer. They know what the radiology report said, so I don’t bring it up again.

I am just a medical student, I think.

She never complains. Not from post-operative pain, not from shortness of breath, not from coughing, not from anything. I take my time with my physical exam, ensuring that I don’t miss any tenderness. I don’t want her to suffer unnecessarily. “Surgery is painful,” I tell her, “make sure you let us know if you are in pain.” She agrees, but never complains.

The nurse corners me one afternoon, and asks me, “Is there any way to put in an order for morphine PRN (Pro re nata- Latin for ‘as the circumstance arises’) for her?”

I am just a medical student, I think.

“Why?”, I ask.

“Because when her family isn’t here, when she’s alone, she cries. She’s in pain, she’s scared, but she’s a silent sufferer.”

Oh.

I am the first person she sees every morning, and I try to make sure she’s comfortable. I offer extra blankets, water, anything I can do just to make sure she is as happy as she can be. She appears more and more cheerful, and I spend what seems like hours holding her hand and chatting about life, the weather, her family, my family, my future goals, my girlfriend. I show her pictures. We laugh. We smile. But her eyes remain anxious and worried.

She says she likes my bowties, so I make sure to wear one every day for her. And I tell her, “I thought of you when I put this one on this morning.” She smiles through those tearful, anxious, worried eyes. I smile back. And that is enough to make my day.

I walk in with my bowtie and smile around 6:30 pm. She just got back from the CT scanner, and her family is around her bed, as per usual. I visited, just to say good-bye for the day. The sun dips a few degrees further west, just enough to peak through the curtains, and her husband turns to me and says, “Edwin, thanks for bringing the sunshine.”
I stand there, in a loss for words, armed with little more than a bowtie and a smile.

I am just a medical student, I think.

Fred Rogers, Mr. Rogers said, “there’s something of yourself that you leave with every meeting with another person.”

*Some details and identifying characteristics have been changed to protect the privacy of the patient and their family.

***

About Edwin Acevedo

Edwin Headshot
Edwin Acevedo, Jr. is a first-generation college graduate from Passaic, New Jersey. He is the son of hardworking Puerto Rican parents, who strongly emphasized the value of an education, and pushed Edwin to become the best student that he could possibly be.

Edwin graduated Cum Laude from Rutgers University in 2011, with concentrations in biological sciences, public health, and psychology. He is currently a third year medical student at Robert Wood Johnson Medical School where, among numerous other activities, he serves in leadership roles for the Student National Medical Association (SNMA) and SALUD, an organization associated with the Latino Student Medical Association (LMSA).

He is devoted to his family and his girlfriend of 6 years, and knows that none of his successes would have been possible without their continued support and encouragement.

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Eyes

I walk – coffee and census in hand – to my patient’s room. I never met her, so I begin my skepticism and study of ‘what ifs’ on the way.

What if she doesn’t trust me?

What if she’s really sick?

What if I don’t know how to help?

I set aside my apprehension and doubt, and I begin to read her story, ”47 year old female with a past medical history of hypertension, presents with…”

I hear someone approaching from the other side of the hallway, and I stop reading to do that friendly smile that I like to do to acknowledge someone’s existence. And just as my eyes meet his, my heart sinks through soles of my feet, through the floor, and becomes trapped in a wooden box deep beneath the foundation of the hospital.

He smiles back, but his eyes tell a story. A story of worry and sorrow and anxiety and worry. And worry…

He smiles back, but I don’t see honesty. I see deceit and an attempt at cordiality. I see pain and an almost disdain for me, for people in white coats, for people that are supposed to help him and his situation.

He smiles back, but I see different emotions behind those dreary, hopeless eyes. I see his eyes rimmed with dark circles, and I wonder if he’s slept at all. I see a yearning for escape. I see a person too broken and too distraught to smile with conviction.

He smiles back, but I see that he’s disconnected. And in that moment, I see my father, my uncle, my brother-in-law. And I want nothing more than to hug this stranger, and try to wrestle some of his pain from him with my embrace.
He smiles back, but his eyes don’t smile.

I walk further down the hall, and I couldn’t help but look back at him and observe his posture, his gait, his existence.
I press the button for the elevator, and stare at the story on the paper, trying to read, but far too affected for the words to register.

“47 year old female with a past medical history of…”

I stumble on that line as the elevator climbs to the sixth floor.

“47 year old female with a past medical history of…”

I find myself at the door to her room.

I walk in, and I take one look at her. And somehow I know that I just met her husband downstairs.

Those eyes.

***

About Edwin Acevedo

Edwin Headshot

Edwin Acevedo, Jr. is a first-generation college graduate from Passaic, New Jersey. He is the son of hardworking Puerto Rican parents, who strongly emphasized the value of an education, and pushed Edwin to become the best student that he could possibly be.

Edwin graduated Cum Laude from Rutgers University in 2011, with concentrations in biological sciences, public health, and psychology. He is currently a third year medical student at Robert Wood Johnson Medical School where, among numerous other activities, he serves in leadership roles for the Student National Medical Association (SNMA) and SALUD, an organization associated with the Latino Student Medical Association (LMSA).

He is devoted to his family and his girlfriend of 6 years, and knows that none of his successes would have been possible without their continued support and encouragement.

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Free Time in Medical School?!: Being a Tour Guide Director

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It’s already November and I can’t believe that the semester will be done in a few short weeks! Even though I have been in school since mid-July, it seems like it was just yesterday that I was starting my second year of medical school. Since the last time I posted, I have finished the renal and hematology/oncology units and am now in the midst of the endocrine unit. My days are filled with learning hormones and their associated diseases when the specific hormone is deficient or excessive, such as diabetes mellitus, hyperthyroidism, and so much more. Despite all the time that I spend in class and while studying, I still make time for the things outside of medical school that I am passionate about. Consequently, I am one of the Tour Guide Directors for the year and work closely with the Admissions Office at VCU School of Medicine.

As a tour guide director, I, along with 39 of my classmates, give tours to prospective students on medical student interview days. In addition, we also facilitate different recruitment events throughout the year for high school and college students and provide special tours for alumni. Along with some administrative work, I have also been able to learn more about the medical school admissions process. After experiencing it firsthand as an applicant, it has been eye-opening to see how the admissions process literally takes a village to coordinate and ensure that each interview day runs smoothly.

Being a tour guide director has been a valuable experience for me because I am able to share what makes VCU such a great fit for me with other prospective students. From the tours where I am able to talk about VCU’s rich history as the oldest medical school in Virginia to the small group settings where I am able to answer individual questions about clinical experience and other aspects of the application, I have enjoyed meeting potential new classmates and bonding over our common goal of going into medicine. Moreover, I am able to show off the McGlothlin Medical Education Center, which has been the new home of the medical school since March 2013. Most of all, I am able to illuminate what I love most about my school and hopefully capture the energizing and supportive environment that I have come to live by on a daily basis as a second year medical student.

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Letter to My Donor

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Photo Credit: Leonardo Da Vinci, Royal Collection, Study of Arms and Shoulders, The Queen’s Gallery, Palace of Holyroodhouse

Dear Sir,

My name is Elorm Avakame and we met two weeks ago. Of course, you don’t remember me – you never will. Yet I will carry the memory of our first meeting as long as I live. We had both planned for such a meeting, though neither of us knew exactly who the other would be. I must admit that I was strangely nervous to meet you. While I tend to approach most new experiences with youthful bravado, I found myself unsure of how I would react to our introduction. I wanted to clothe myself in a shroud of detachment to protect myself from reacting strongly but found myself unable to. Doing so would have detracted from the importance of the moment.

The moment of our introduction remains a vivid memory. I stood next to you, awash in equal parts excitement and trepidation. You lay peacefully, lifelessly, with a serenity that is only achieved when one has finished his life’s work. I remember being immediately struck by the reality of your humanity. When describing you prior to our meeting, I had used words such as “cadaver” and “donor”. In that moment, I realized that the man who lay before me was known by very different terms –perhaps as father, husband, or brother. Certainly, you were known as a son and as a friend. While I never had the great fortune of knowing you in life, I consider it a privilege to know you in death. Ironically, the circumstances that made our encounter possible brought great joy to my loved ones but profound grief to yours. Our time together marks the beginning of my career as a healer of the human body, but it was only made possible by the end of your time on this earth.

Over the next several weeks, I will attempt to commit to memory the organs, tissues, vessels, and nerves that worked in beautiful harmony to give you life. At times, the enormity of this task causes me to lose sight of the significance of the experience. At other times, however, I am overwhelmed by the meaning of it all. For instance, after I had drawn my scalpel blade across your palm and peeled your skin away on a determined search for the structures that lay underneath, I suddenly became aware that I was destroying the very hand that was a source of comfort to those you loved. In the coming weeks, I will dissect your heart, the engine that quietly pumped your life-sustaining blood until it was silenced forever. I will hold your brain — which carried all of your memories, fears, hopes, and dreams — in the palms of my hands.

These moments serve to underscore the magnitude of your gift. By choosing to donate your body for my education, you chose to forgo a traditional funeral and burial. You did so knowing that your body would fall into the hands of an inexperienced student. Indeed, as one physician so perfectly stated, this is one of the great paradoxes of medicine — we learn to heal the living by dismantling the dead. Sir, you lived, you laughed, you loved, and you ultimately died. Yet even in death, as the lessons I learn from you empower me to change the lives of my patients, you will live on. Thank you for your investment in the future of medicine. Thank you for your investment in me.

Yours truly,
Elorm F. Avakame
Harvard Medical School
Class of 2017

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“It was the best of times, it was the worst of times…”

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Charles Dickens began his classic “A Tale of Two Cities” with that iconic phrase, and I can think of no better way to summarize the beginning of my medical school experience. It truly has been the best of times, but at other times has felt like the worst. Medical school is turning out to be everything I thought it’d be and more – in some great ways and some difficult ones.

Though I may seem ambivalent about my experience, make no mistake – these have absolutely been the greatest eight weeks of my life. My White Coat Ceremony was a particularly unforgettable moment. Words cannot describe what it felt like to finally be able to wear my white coat for the first time. To most people, it may appear nothing more than a piece of uncomfortable white fabric that seems made to fit everyone and no one at the same time. However, for those of us who spent long nights in undergraduate libraries longing for the privilege of owning one, it is almost sacred. It represents our official acceptance onto the pathway of the profession of our dreams. It seemed to mean even more to my family than it did to me! It was so gratifying to see my family swell with pride, and I am eternally grateful to have been able to share that moment with them.

Interviewing my first patient was an equally amazing experience though it was profoundly humbling. There I was, in a real patient interview room, with my professor and my classmate watching, trying my hardest to remember what exactly I was supposed to be asking this very real patient. Even as I was hoping that I was asking my patient the right questions, I was praying that he wouldn’t ask me any questions because I’d most likely have no idea how to answer them. In that moment, I was confronted by just how much I didn’t know. Yet that realization was inspiring in itself because I realized that I’m actually being trained to become a physician. I was intensely focused on making it to medical school while I was in college, but in some way I didn’t fully comprehend that making it to medical school would mean I’d become a real-live doctor. These patient experiences have helped that I’m not just a student anymore – I’m a physician in training.

While this truly has been the greatest time of my life (for more reasons than I can fit in one blog post), I would be remiss if I did not admit that it also been the greatest challenge I’ve ever experienced. I had often heard that medical school makes college feel like middle school, and I always thought that folks were exaggerating. They weren’t. The volume of information that I’ve been asked to master has often been overwhelming and I have struggled to adjust to the pace of learning. Within the first two weeks of class, I found myself doubting that I have what it takes to make it and genuinely wondering whether or not I deserve to be in medical school. These feelings are compounded by the fact that many of my classmates seem to have been born speaking biochemistry. I expected medical school to be mentally challenging, but I underestimated the emotional and even physical challenges that I would experience. Ironically, I’ve learned that everyone thinks they’re the only one that doesn’t have it all together. We find support in each other when we feel overwhelmed. I genuinely feel like I have the most amazing classmates in the world. If I wasn’t among a group of such kind, supportive, caring people, I’m really not sure how I’d cope.

Life in medical school has been a whirlwind. There have been amazing highs, but there have been difficult lows. Through it all, one thing is for sure: it is an honor and a privilege to have this opportunity and I am committed to making the most of it.

Elorm and his parents

Elorm and his parents

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Saving the Simulation Patient

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Since starting medical school, sitting in an auditorium and learning from lectures has been a mainstay of my preclinical education. Although I gain a lot from the lectures as an auditory learner, I have enjoyed being able to go beyond the traditional classroom through various small group sessions that have been incorporated into the curriculum. I have been able to learn in a more interactive setting as I practice history taking, physical exam skills, and differential diagnosis brainstorming and go through pathology cases with my classmates. Nevertheless, my most unique small group experience has been the human patient simulation experience in my pharmacology course.

In the human patient simulation experience, I worked with five of my classmates to determine the cause of our patient’s drug overdose and to administer the appropriate treatment. Before going into the session we had assigned roles for each person such as lead physician, secondary physicians, pharmacist, laboratory specialist, and reporter. By doing so, we ensured that each team member could contribute to the patient’s care in a meaningful way.

Walking into one of the rooms at the Center for Human Simulation and Patient Safety was like entering a typical hospital room. I noticed the gowned patient in the bed, the vitals monitor, and assorted medical equipment. Although our patient was a mannequin, he could blink, breathe, produce a pulse in various parts of his body, and even talk! My team and I initially took the relevant vital signs, including blood pressure, heart rate, respiration rate, pupil size, and abdominal activity. Consequently, we noticed that his heart rate was significantly increased and his pupils were dilated. Yet, these vital signs were not enough to figure out what was going on. We asked questions to probe more deeply about his symptoms, and found out that he was experiencing dry mouth, weird dreams, and had eaten some mysterious flowers from his friend Jimmy. After discussing the different possibilities, we thought that the patient’s symptoms could be attributed to atropine, most likely found in the flowers that he ate. With three minutes to spare, we administered the antidote to atropine poisoning and the patient’s adverse symptoms began to reverse.

By working together, my team and I were able to pool our collective pharmacology knowledge and apply it in a clinically relevant way. It may not have been a real patient, but the simulated scenario taught me the importance of collaboration and teamwork in establishing an effective care plan for a patient. The lessons from this pharmacology simulation experience have been valuable and I hope to do more simulations in the future.