Monthly Archives: September 2013


September 11, 2013

This evening, I listened with my stethoscope for the first time.

I have been waiting for the perfect moment ever since I received it a few weeks ago, and I felt that this evening was finally the time.  I had my first patient encounter today for my baseline assessment, which gave me the opportunity to meet with a standardized patient (a person portraying an actual patient).  It was both an eye-opening and humbling experience, and it drove home just how much I have to learn.  Thankfully, that is what medical school is about—the continual process of learning and doing our best to make each day a little better than the one before. 

I felt that it was symbolic for me to use my stethoscope for the first time on the day I met my first patient.  I have taken anatomy for nearly three weeks, have made it through my first quiz in Molecular Foundations of Medicine and can now name most of the coronary arteries, but today brought into sharp focus the fact that I am a physician-in-training.

Since today was a baseline experience, I had really no idea what to do once I entered the simulated exam room.  I did know that I needed to wash my hands with the sanitizing foam.  (Thanks to the generosity of the automatic foam dispenser, I was faced with the conundrum of drying my hands while trying to introduce myself.  Somehow, wiping my hands on my white coat didn’t seem suitable, so I settled for vigorously rubbing them together.)  I also remembered to introduce myself with my full name and indicate that I am a first-year medical student, but as I sat down, I realized how much I didn’t know.  What questions do you ask?  How do you follow up those questions?   

What do you do when you end up completely tongue-tied?

Yes, that happened to me.  My mind went blank about half a minute into the conversation, and I couldn’t think of what to say next.  Bewildered, I picked myself up after a few moments and kept going, realizing just how far I had to go.

So much to learn…

Today’s baseline encounter has been a very valuable experience, and one that will frame my studies in the coming months.  I know that with time and practice, I will gain the knowledge I need to ask the right questions, but I’m also thankful for this experience because it helped me to see what patient interactions can look like when I don’t come in with much of an agenda.  I hope to gain the structure and skills I need to effectively communicate and gather the information I need, but I also hope to preserve some of the emotions I felt today.  They anchor me in humanity.

I arrived home under a sky that looked like the ocean.  Swaths of coral clouds banked against the pale blue expanse, sea foam on the waves.  The air was beginning to take on the lightest chill.

After dinner, I sat down and lifted my stethoscope from its box.  Outwardly, the moment didn’t appear ceremonious, but it meant a lot to me.  I placed the diaphragm of the stethoscope against my shirt, just to the left of my sternum.  According to my anatomy lecture this week, this location—the left sternal edge of the second costal cartilage—was the best place to hear my pulmonary valve.  This is where deoxygenated blood rushes to my lungs, extracting life from every breath.

I heard nothing.

Since I knew I was still alive, I decided that it was a technical issue on my part and flipped the chestpiece over to its other side.  Instantly, the rhythmic thud flooded my ears with all the intensity and wonder of hearing the ocean within a shell.

I was startled by how amazing it felt to hear my heartbeat.  In anatomy dissections this week, I peered into the chambers of the heart, felt around the valves, and compared the thickness of the muscle in the left and right ventricles.  As fascinating as this was, hearing the living pulse of my heart was like glimpsing a vibrant painting after seeing the preliminary sketches. 

I rotated the chestpiece so that I could use the diaphragm to listen and began methodically working my way through the four positions on my chest, hearing a discordant roar in my ears as the diaphragm brushed the folds of my shirt.  Every sound was enormously amplified, and I could hear my fingers on the chestpiece rim as I located the four landmark points we learned in anatomy.

Second costal cartilage, along the left sternal border…the pulmonary valve.

Second costal cartilage, along the right sternal border…the aortic valve.

Xiphisternum…the tricuspid valve.

Fifth intercostal space, along the midclavicular line…the mitral valve.

I cannot yet identify the different types of sounds I heard this evening, other than the lub-dub that marks the rhythm of systole and diastole, but I know that with time I will learn.  Just like how I will learn the steps to gathering my patient’s history, and how I will learn to communicate gracefully and with confidence.

But in this moment, I know I can listen.

Week Two, Quiz One

I am a little more apprehensive than I thought I would be as I sit in the classroom, waiting to take my first quiz in Molecular Foundations of Medicine.  Although it’s only our second week of medical school, we’re already halfway through Mini Quarter and heading quickly towards our final exams later this month.  It is hard to believe we have already reached the halfway point.

This quiz, given under final exam conditions, will help me to evaluate my med school study skills, and I am both eager and anxious to receive its verdict.  We have covered a prodigious amount of information in the past two weeks, and I am still trying to determine which study strategies would be best to use.  Flash cards?  Additional online resources?  Reading and re-reading lecture notes?  Drawing things out?  It will probably be a mixture of them all, and I am hoping that the combination I have chosen over the past fourteen days has been the right one for me.

The rows of tables which usually span the classroom have been rearranged so that we are sitting in pairs.  I take a drink from my water bottle, dig through my backpack to find my watch, realize I have forgotten it, and locate the clock on the wall instead.

Only a few minutes until we begin.

Turning in my chair, I glance around the room at my classmates.  Although I’m still working on learning everyone’s names (something I really hope to accomplish by winter break–I think I’m about 66-70% there), the faces have become familiar.  We are all in this together, I realize.  Our shared hopes and goals have brought us together on this Friday morning, and suddenly, I feel a little less nervous.

About half an hour later, it is over.  I follow several classmates to the elevator, wondering what they think about the past thirty minutes.  While the quiz has been challenging for me, I am satisfied overall with how the morning has gone.  Entering the hall, I move on to the next part of my day–lunch, a meeting, our weekly journal club, histology lab.

Coffee break.


As the sun sets over Stanford, I receive a notice that our grades are up.  Fingers crossed, I log onto our course website and click the link to my gradebook.  My eyes flick across the screen, honing in on a number written in black 12-point font.

I have passed!

Now, on to studying histology…


And in closing, a few random thoughts inspired by my week:

You know you’re an anatomy student when…

…You go out to dinner with a fellow med student and find yourself discussing bone saws and preserving fluid while waiting for your meal to arrive.

…You watch dissection videos while eating lunch.

…You realize that one of the highlights of your day was mastering the attachment points of five different muscles.

…You are looking for a scalpel and accidentally tell your classmate that you can’t find your scapula.

Have a great weekend!

First Week

I saw his hands for the first time on Thursday.  

Before then, they had been protectively gloved in light cloth mitts, as if they held a story I could not yet hear.  Since Thursday was only our second day of anatomy, I had not expected to glimpse our body’s hands for a while yet, but we needed to abduct the arms in order to dissect along the midaxillary line that afternoon.   Since I was the closest to the hand on my side of the dissecting table, I reached over and rolled the cloth away from the skin.

The hand was larger than mine, bluish.  Gently reaching in, I grasped it, feeling its cold, firm touch against my own.  There was something almost waxen about it, as if it had been carved from a fusion of marble and earth.

For a brief moment, I locked my hand with his, trying in my own way to connect with this life I would never meet.  I will know no details of this man’s story, but I wondered whether a child once held his hand in the way I did now.  Did this person have children who looked up to him in the same way I look up to my dad?

Who were you?

I like performing dissections—in undergrad, I enjoyed my zoology course, and I continue to be fascinated by the intricacy of surgery.  Anatomy is no exception; it is so amazing to peek into the human body, and although the thought of learning so many nerve and muscle names can seem rather daunting, I am up for the challenge.  At the same time, part of me feels vaguely disconcerted by the fact that although I will know the details of this person’s inner being more thoroughly than any other, including my own, I will never know this life.

That is why I am so glad that our class took a moment of silence before our first dissection lab on Tuesday.  The thrill of exploration merges with the gravity of the gift I have been given, like treble notes and bass notes coming together into a musical score.

A musical score which, at the moment, seems to be composed mostly of 32nd  notes.

We are in mini-quarter right now, which is a five-week period of intense coursework designed to ensure that everyone begins medical school on the same page.  In addition to anatomy (which will continue for two full quarters), my classmates and I are taking a month of molecular biology and histology.  I love my classes, although at times this week I’ve felt like I’m going down a freeway at 65 mph while trying to glimpse the details of the edge of the road (as a passenger, I might add, since I prefer to arrive at my destinations in one piece).

Thankfully, even when the edge of the freeway is a blur, the horizon remains clearly in view.  Through the patient experiences integrated with our coursework, I have glimpsed how the details of molecular biology fit within the context of health and disease and have witnessed the very real and human side of all we are learning.  The patients who have given deeply of their time, energy, love, and lives to speak with us are the words to the musical score I am learning, this music of medicine.

To them I dedicate this haiku:

You shared your story
With me and in that moment
Your life helped shape mine

To all those supporting me on my journey to physicianhood—those both present and past—thank you.