Rotation 101: My First Goodbye

By: Punita Shroff, OMS-III

After spending months studying for the boards, passing and then finishing the intro to clinical medicine, it felt like a weight had been lifted. I was finally a third year. It was only a few weeks ago that I walked into the hospital in my newly minted white coat. I felt some kind of renewed purpose, a breath of fresh air after spending the better part of the first two years of medical school studying and memorizing facts.

As fresh-faced third years, we envision ourselves in capes – Superman style – we live in this ideal world where we’re going to save lives, cure ailments and bring life into this world. But as soon as I stepped into the hospital, I soon learned that those ideals are replaced with the honest reality that not everyone can be saved or cured and that as grateful we are to bring those into this world, we must come to learn to say goodbye to others.

Within the second week of my medicine rotation, I saw a patient die. It wasn’t glamourous or even in slow motion like it occurs in the movies sometimes, but the minutes that passed as I watched a man catch his last breaths are forever embedded in my mind. Old age, severe dementia and respiratory failure was the only information I was given. I barely knew the patient, but on that Saturday morning my on-call team was responsible for our patients and anothers team’s patients. He was a patient on the other team who was supposed to be discharged that day but who had suddenly presented with progressive respiratory failure.

I wasn’t prepared to hear the words, “He’s going to die soon”; even uttering those words seemed wrong, a painful brutal reality. We all hope in these circumstances that some miracle will come about. Sometimes there really is nothing that can be done, and this was one of those situations. We made him comfortable, and with the request of the family stopped any orders of tests. So my team patiently watched, we watched him catch his last breath, and we silently waited. We stood supportive in the room as his family came in one by one. In those fleeting yet unforgettable moments, his family poured their love and emotion to their loved one and bid their final goodbye. It was gut-wrenching.

As future physicians, we’re going to see patients on a daily basis. At some point, life becomes a routine and for some, perhaps even mechanical. We’ll see patients progress, deteriorate or even worse, pass away. We’ll hear about horror stories of doctors becoming cynical or jaded. That is a sad reality. I hope though that my story and hopefully your stories bring light to what’s most important; these patients are human too and that for every patient there’s a family of supporters.

As those ideals of medicine eventually fade, don’t let your compassion and love for what brought you to medicine change as well. It’s what will make us all better doctors someday.

Summer in Haiti

By: Warda Zaman, OMS-II & Yuliana De los Santos, OMS-II

Contributors: Elizabeth Barr, OMS-II, Iwona Dziewa, OMS-II, Bhuma Krishnamachari, PhD, Bill Blazey, DO

Team Haiti using OMM on a patient, assessing and establishing pain scale in Creole when needed

We are not going to tell you how the 7.0-magnitude earthquake, one of the worst disasters faced in human history caused the death of about 222,000 and caused dreadful injury to more than 300,000 people.  This is an underestimated number if you consider the long-term post-psychological trauma faced by several survivors. Nine months later, a cholera epidemic struck Haiti, the first time in over a century. We are sure you have heard all about it in the news and may have donated the $10 to yélehaiti. Volunteers have come and gone (and continue to go as exemplified by yours truly) to provide medical care, working tirelessly under extreme conditions with no electricity and limited resources. Predictably, the situation is worsened by damaged infrastructure and communication systems.                   

We are also not going to share with you, how despite more than $2 billion in foreign aid, Port-au-Prince still has leveled buildings, and structures littered with rubble, including its National Palace.  More than 550,000 people are still in encampments clustered around the capital, living in conditions that are unfit for habitation. This is the scene our team of five NYCOM first-year medical students supervised by William Blazey, D.O. and Bhuma Krishnamachari, Ph.D., landed in Port-au-Prince after a quick 3.5-hour flight from JFK to see.

But we are going to share with you how when we landed in this beautiful country, we were greeted with a hug and smile by our host, Pastor RoRo, a Haitian-American who supervises the four Haitian Christian Outreach (HCO) mission camps throughout Haiti. How during the 47-mile drive that took 5 hours across rough roads and construction to our final destination- Peredo Community Hospital, we received a crash course on Haitian culture and language by Carey and Mike, a couple from Indiana who had been volunteering with HCO for over a month.  Although the long ride was bumpy and tiring, the breathtaking views of the mountains and the Caribbean Sea were enough to dissipate the exhaustion.

Team Haiti helping in closing the wounds of a lady attacked by machete

The Hospital Communautaire de Peredo- Peredo Community Hospital is located at a camp site along with the guest dorms which allowed us to become familiar with the clinic from our first day. Carey, along with Ally and Allison – two summer interns who were a great help in adapting to the living and social conditions of the camp site, had cleaned the clinic, organized the pharmacy, and started seeing patients a month before we arrived. Due to the existence of the Community Hospital, the locals do not have to travel more than an hour and half to a Cuban hospital in Caye-Jacmel, but can save that trip for dire emergencies.

Once they heard that a medical team (word spread that there were six “doctors” at the clinic) arrived, they began lining up starting at 6am and kept on coming until late-afternoon; traveling from near and far. We, medical students, worked in teams of two with Dr. Blazey swinging by to confirm our findings, make a diagnosis and prescribe any medication as necessary. Our days consisted of working in the Hospital from morning until early afternoon, spending afternoons participating in cultural activities and evenings reviewing the day’s work and engaging in structured educational discussions.  The discussion sessions, led by each student member of the team and facilitated by Dr. Blazey, were designed to educate the team about different disease pathologies in the context of Haiti.

Yuliana, part of Team Haiti, treating with OMM

We saw familiar diseases like heart diseases, gastrointestinal diseases and diabetes, but then we also saw diseases created by the results of poverty and injustice like malaria, typhoid, skin and soft tissue infections, easily preventable in resource-rich countries but commonplace in Haiti.  We saw many cases of tinea capitis, recurrent fungal infections, several upper respiratory infections in children, most of who were malnourished, and even some sexually transmitted diseases. We saw more than 350 patients at the clinic in 7 days, not counting follow-up visits, of which there were many.

What alarmed us the most was a case of a woman brought in after being attacked with a machete.  We were told that she was a homeless lady who was mentally ill.  We were not able to confirm why she was attacked but she had multiples open-wounds including a large one on her right leg, a left pinky finger hanging off her hand and a wound right above her right eye.  She was so strong that it required the whole medical team to hold her down while Dr. Blazey stitched her wounds (he managed with 7 stiches versus what would be 14 stitches here in the US).  That same morning we experienced the difficulty of managing chronic disease in a resource-poor country.  We saw a diabetic patient whose blood sugar was so high, she was close to a diabetic coma.  We stabilized her to the best of our abilities, and sent her to the hospital in Caye-Jacmel. Needless to say, that was an interesting and busy morning.

We also want to share with you that our time at the Peredo Community Hospital was a very rewarding one.  Living in the countryside for 10 days allowed us to appreciate how beautiful the land and the people of Haiti really are.  We all felt so privileged to be able to help the people of Peredo and meet the wonderful volunteers that spent their time at the camp site.  While we were at the HCO mission camp, we had the pleasure of befriending a group of volunteers from Ohio who were of great help to us in our work at the clinic.  It was truly wonderful to be surrounded by people who wanted to help others without expecting anything in return.  This trip was a life-changing experience that we will always cherish.

Team Haiti at the Peredo Community Hospital

It’s Impossible to Say “No” to an Abuela

By: Sarah Ng, OMS-II

This past July, a team of NYCOM and NYIT students and faculty travelled to El Salvador to participate in fieldwork as part of the Center for Global Health Program. The team was led by Dr. Zehra Ahmed, Dr. Michael Passafaro, and Dr. Deborah Lardner, and included Hau Chieng (’15), Ryan Denley (’15), Dane Masuda (P.A. ’14), Michael Nickas (’15), Sarah Ng (’15), Jasmine Beria (’14 Academic Scholar), and Jon Giordiano (’14 Academic Scholar).  During our three weeks there, we were able to shadow doctors and health promoters, successfully carry out a clinical study on Chagas disease, run health fairs for students of all ages, practice new clinical skills, enjoy breathtaking scenery, learn about a new culture and history, and much more!  Each of us took turns blogging about our experiences while we were in El Salvador, which was posted on the NYIT homepage during our time there. (http://www.nyit.edu/global_health/el_salvador_2012/)  We thought we would share a few excepts and photos from the blog here.

Today was an extremely full day. We woke up at 5:30 a.m. so that we could head over to the community of Los Cimientos, which was a three to four-hour drive – you lose track of time on these types of trips. We spent the first hour in our regular blue van, but the majority of the time, we sat in the back of a mid-size Toyota pickup truck. We had to travel up to the top of the mountain to reach the community. Even though the seating was uncomfortable for most of us, the sights never got old. We passed children playing soccer, dogs laying in the middle of the road, cows herded up the mountain, farmers taking work breaks in the shade, and beautiful, cloud-perched mountains sitting in the distance.

In the span of fifteen patients, we paid witness to a sixteen-year-old discovering she was pregnant for the first time, a woman who lost her pregnancy while recovering from toxoplasmosis — a rare disease in the United States, but more common in Central America,  a five-day-old baby boy who was extremely good-tempered despite his abdominal hernia, a slew of complicated and uncomplicated upper respiratory infections in children—a major concern in this region, and an elderly man with multiple chronic illnesses driving him into frailty.

Helen, the local Peace Corps worker, was able to organize a Pap smear clinic for us in the morning. The women in El Salvador tend to be nervous and embarrassed about the procedure—not unlike us. However, as a result, they will rarely volunteer for the test; we learned that last year, during an attempt to run a similar clinic, only a couple of women were willing to receive one.

This year, it so happened that a non-profit organization donated 25 solar lamps to the community. Helen was unsure of how she would distribute this finite and popular resource, but then she had an idea: she could offer a solar lamp to each woman who agreed to receive a Pap smear exam. And so, 25 lucky women left the clinic with both an environmentally-friendly light source as well as a helpful preventative measure for cervical cancer!

Dr. Ahmed, Michael, Helen—the Peace Corps volunteer that we met in Los Cimientos— and I followed médico promotor Marvin and his colleague to a local school where they spoke to a class of ninth graders about Chagas prevention. The presentation was remarkable, as it precisely tackled all the critical points about the disease. It also motivated the children to participate and ask questions. At the end of the session, Dr. Ahmed  gave the students a quick lesson on the purpose of our using an EKG in our Chagas study, and also on how to obtain an EKG exam for themselves. She thanked the class for having us.

Our last visit today took our group up a mountainside to visit the lone house on that particular trail.  I can’t even talk about the scary and steep drop-offs or the number of times I slipped or sunk into the mud because I know doing so will only upset me, but we’d heard the old abeula we were visiting was capable of making the trip without any difficulty at all.

On arrival, to my sight and to anyone else’s who’d graced that mountain home today, I saw an alert woman working hard by her indoor wood-burning stove.

After I asked her permission, she allowed me to take a picture of her methodically rolling out tortillas.  She was a very generous host to Dane, Sarah, and me, and happy to have us in her home.  She insisted on serving us some of her food.

Obviously, it’s impossible to say ‘no’ to an abeula.

We ate our tortillas with beans and some cheese taken from a bowl of mountain water.  It was delicious and we left nothing behind.

After assessing her normal blood pressure and asking some basic health questions, we checked her water basin—or pila—for contamination and left her home with a smile and an embrace.

Today was a big day for the five of us who are now second-year students, both D.O. and P.A. alike. We ran a health fair for a school in Yamabal; the fair has been over a month in the making. With the coordination of Peace Corps volunteers Alex and Elsa—Alex teaches at a local elementary school—we educated 40 fifth and sixth graders on nutrition, exercise, the lungs, the heart, and oral hygiene.

…To give the children some perspective on what happens when a person develops high blood pressure, he organized a “human” blood vessel, where NYIT students and faculty served the roles of vessel walls and children played the roles of red blood cells.  NYIT members stood opposite each other an arm’s length away from their neighbors– fortifying vessel walls just wide enough to let our eager red blood cells pass through two-by-two.  We asked the children to repeat the trip, but this time the NYIT members bottlenecked the end of the vessel to simulate a narrowing of the arteries and an increase in blood pressure.  Then, the illustrious Dr. Lardner played the role of a lifetime as arterial plaque impeding our red blood cells’ clear passage through the vessel.

…The constant integration of new lessons with ones we discussed earlier in the day was central to the success of our health fair. Teaching the interconnectedness of healthy choices and their effects on all the systems of the body was our primary objective. The enthusiasm and energy these young children exhibited for nearly three hours can only be a sign that today’s health fair will have a positive impact on their lives. This day showed me that even with obstacles like a language barrier, the right attitude and preparation will lead children to pay attention to your every move and learn from you–even if your Spanish sounds a little funny.

Before I go into anything else, let me be the first to tell everyone that we reached our goal of 300 patients today! Some of us thought it would take two full weeks, while others thought getting 300 patients in our three weeks here was going to be too tall a task; no one anticipated that we would be able to complete electrocardiograms (EKG’s) and venous blood draws on 308 locals in just three days.

So congratulations are in order for Jasmine and Dr. Passafaro, as well as for everyone else who helped them along the way.  This study has been more than half a year in the making. We believe it is going to be a significant stepping-stone in the screening for Chagas, no matter which way the results fall.

I hope you two remember us little guys on your way to stardom.

Coming Full Circle: SAAO’s Summer Preceptorship Program

By: Lauren Iacono, OMS-II

Take your hands and place them on your lab partner’s ankles… now just feel whatever may come to you…” – A memorable and bewildering assignment from OMM lab one at NYCOM. As first year students, we are introduced to the concepts and theories behind Osteopathic Medicine and Treatment. Simultaneously, we begin dissecting a human body and learn what is beneath the skin of our “patients.” Skin, fascia, muscle, ligaments, bone… circulation, innervation, lymphatics… All the pieces that compose one as a whole and all the pieces that you “dissect”  in order to learn about and treat the patient.  During our first year, we learn the basics behind each of the principles and treatments of OMM; we learn the proper technique and how to place our hands, how to approach the patient, and as time goes on to “assess” and treat with our hands. For the most part, we learn by working on our classmates, whose main chief complaint is a somatic dysfunction from long hours of studying. We learn through clinical case studies in class and how we would approach the patient from a practical aspect. However, it is rare that in our first year, we go beyond treating and learning in the lab or classroom.

For me, what I learned in class and lab was just enough to get my feet wet and spark an interest that allowed me to want to learn even more within the realm of OMM. So as the end of the school year was approaching, I knew I wanted to spend my summer learning more about OMT treatments and techniques, as well as observe how it is applied clinically on patients with a variety of dysfunctions and illnesses. At this point, I was so thankful to be a member of SAAO, which had an established OMM Summer preceptorship program. The program runs during the summer months of June through early August, in which first year medical students have the opportunity to be a part of. Each week different workshops are facilitated by various Osteopathic Physicians from both outside and within the OMM faculty department, scholars, as well as yoga and tai chi instructors. Along with this the students get to shadow and work with two to three OMM faculty members at the NYCOM health clinic. At the end of the summer, with the completion of attending a certain percent of the workshops and the required shadowings, each student receives a certificate for the participation.

The workshops included more practical aspects of OMM, such as common office techniques and alternative approaches to patient education. Other workshops focused on the clinical correlations including orthopedic considerations, physical medicine and rehabilitation, as well as treating allergies and asthma with OMT. While some focused on specific treatment techniques and how they are applied in the clinical setting such as the Still technique, HVLA, lymphatic considerations and treatments and Chapman’s reflexes. Some workshops went beyond the realm of OMT and allowed us to learn more on yoga, tai chi and acupuncture, and how these topics also apply to healing and treatment. Lastly, we also had scholars and residents present to us on their view of how to approach OMM during rotations and what it is like to be an OMM resident, respectively. Each workshop gave me further insight behind the philosophy and teachings of OMT and allowed me to expand my knowledge and interests regarding osteopathy.

To me, the biggest highlight was also being able to work in the clinic with our faculty. This allowed me to get a more hands on experience in treating patients with a variety of ailments and chronic illnesses.

By working with different physicians I was able to learn a variety of techniques and treatments, as well as apply what I have learned to an actual clinical case!

As I sat, assisting with treatment on a patient (overseen by my attending physician), I reflected back to that first OMM lab experience. As I was treating the patient, hands placed over the ailment, I just felt… felt the changes occurring under my hands as the treatment progressed, from the skin, the fascia, the muscle, the ligament, the bone. That bewildering moment in that first lab, suddenly made sense as I “assessed” the changes occurring underneath my fingers and how all I had learned, throughout the year, came full circle back to this moment.

The SAAO summer preceptorship program was a great experience to enhance my OMT skills and techniques, as well as to expand my knowledge to a more clinical setting. I encourage first years to consider being a part of this summer program to further develop and improve on their OMT skills, learn out of the classroom setting and apply what they have been learning throughout the year in a clinical setting.

I would like to thank the SAAO NYCOM chapter, Meaghan Crooke for being the Class of 2015’s Summer Preceptor Coordinator and Dr. Yao for facilitating and overseeing the program.

 

“A student of life must take in each part of the body and study its uses and relations to other parts and systems.” AT Still

Research at NYCOM

By: Adam Guss, OMS-II

Besides simply trying to learn material and pass/honor systems many students look for new ways to differentiate themselves, bolster the resume, and catch an edge. We have many clubs, organizations, and extracurricular activities on hand. Others find new things simply as good scientists do; with curiosity. Research is one of those ways to put our academic skills to the test and create with our hands and minds.

During this last summer I participated in NYCOM’s Summer Research Program. Dr. Beatty of the anatomy faculty served as my mentor and research advisor as we investigated the hardness in molar substances. Over six weeks we setup an experiment to investigate hypothesized differences in hardness between enamel and dentin based on its location on and within teeth harvested from rats in the lab. After a lot of background reading on microstructure, microindentation, and how exactly to go about working all kinds of new machinery, we set out. After submitting a proposal for the Summer Research Program and getting approval for the project, we performed the experiment, gathered data, and created a detailed poster for presentation. The project certainly exceeded the six weeks allotted due to the level of prep required to write a detailed proposal for approval.

While it may seem at times that the course work is enough to keep anyone busy, research starts with curiosity and a large amount of background reading and this takes time. Part of engaging in any extracurricular is time management and balancing life functions. This remains something to keep in mind even for Officers in clubs and other positions.

But getting into research can often seem to be a difficult leap. NYCOM’s Summer Research Project not only gets students the opportunity to work with the faculty to perform research but also come face to face with the challenges of academia. It can be an incredible experience. But while NYCOM may offer $500 for supplies and a $1500 stipend to the student for the 6 weeks, actually planning and performing the task is rigorous work.

How does a first year go about finding a research project? Well step one is to get acquainted with the faculty. In both OMM and Anatomy lab students have a great opportunity to learn from faculty directly. Approaching a faculty member maybe daunting but they are often incredibly happy to share what they are working on and often will take the time to explain their own research. Finding a project that interests you is often one of the best ways to get involved. Step two normally is just approaching that faculty member and asking about involving them in a summer research project.

Academic Scholars are also close to the research action. Part of being an Academic Scholar is performing a research project with a faculty advisor. Academic Scholars have office hours which can be a good downtime to ask about how they became involved or the projects that they know of currently underway. Because of this, research is also a good means to distinguish someone whom is considering the Academic Scholars program.

Research is incredibly rewarding though, and I’d highly recommend it to students who have not had the opportunity to perform research before .