I think this past week, which was the 2nd week of our 2nd block, pretty much gave me a glimpse of what med school from here up until February of 2010 will be like: pretty crazy. Yes, it is kind of like you're drinking from a fire hose, but it's not as terrible as some people make it out to be. Basically, every Monday, Wednesday and Friday, we have our small group IQs from 8 to 10 followed by two hour long lectures (or interactive medium sized groups) until noon. On Tuesday we usually do some combination of gross lab and histopathology until noon. On Thursdays we have optional review sessions which are videostreamed online.
The theme of this week is "Sweet life." I like how the administration tries being cute about things by coming up with random themes for the weeks. Basically "sweet life" entails endocrinology with an IQ case emphasis on diabetes.
On Monday I got to meet my new IQ group. Group 20 is pretty solid. We tend to work very efficiently. Our facilitator is in his final year of MSTP studies (year number 7 or 8 or something absolutely insane like that). He's a pretty cool guy. Our two cases this week involved type 1 and type 2 diabetes respectively. We learned a bunch about the pathophysiology, diagnosis and treatment of these diseases. After IQ, instead of having lectures, we had a 2-hour long medium sized interactive group discussion regarding a problem set involving intracellular signalling pathways. These small groups consist of about 12 students and a facilitator. I definitely learn a lot from the groups and I seem to stay awake seeing as participation is mandatory.
Tuesdays suck. The reason I dislike Tuesdays is because my two least favorite subjects are covered during these days: anatomy and the dreaded histopathology, which I'm sure you already know about. I didn't mind anatomy in block 1...perhaps because I didn't realize how ridiculous it would become. During the first couple blocks of our program, we are introduced to anatomy solely through prosections. Don't worry, I didn't know what the hell that meant until I got here. Basically, instead of spending all day in lab cutting up bodies and screwing up body parts (dissection), they are already cut up for us. So we rotate through several stations while the professors point all the relevant parts to us. I kind of feel like this is a waste of time...perhaps because I'm not so good at keeping up with the reading ahead of time. Part of the reason why I don't keep up so well with my anatomy reading is because it's so damn boring. Anatomy, while not all memorization, is mostly memorization. I HATE rote memorization. Seriously, we have names for all these random ass things in the body. Who the hell cares? I sure don't, though I should and believe me I will be this Labor day weekend! Honestly, the only cool thing about memorizing some crazy anatomical names is that it makes you sound smart. I have mad respect for all my colleagues doing the masters in applied anatomy. You guys are crazy.
Now Wednesday was interesting. I was 20 minutes late to IQ group. I left home at 7:15 and I got to school at 8:20. Apparently there was some ridiculous accident on the highway and I had to literally ride a 25 mph road all the way into town. My IQ group wasn't really hard on me for being late, but I felt ridiculously bad. I brought bagels for them today, so hopefully I made amends.
What was really cool about Wednesday was that I got to go visit a hospice for a program we have called RAMP. Yes, another god-forsaken, unnecessary acronym which stands for Rotating Apprenticeship in Medical Practice? (I think?). These are basically glorified shadowing sessions where small groups of students are sent out to hospital and community practices to shadow different types of physicians. I was placed in a group to go check out palliative/end-of-life care. Honestly, I wasn't too thrilled about the placement. Seeing people die sure doesn't sound appealing, does it? It turned to actually be pretty cool. We got to talk to a couple of patients in the hospice about their experiences. The one was this sweet old lady dying of what seemed to be lung disease. The other was this middle aged guy dying of Lou Gehrig's. It was kind of cool to see how at peace they were. The actual hospice was really nice inside. It had a nice home-like feel to it, which was a stark contrast to the drab appearance of the outside. The hospice is right next to the lake, so some of the residents have an amazing view. One cool thing I learned was that Medicare pays for the cost of hospice care provided that your prognosis is that you will die in 6 months or less.
Thursday was pretty much a review day...nothing too exciting school wise. A couple cool things though. First, I got to eat dinner with an old friend from high school whom I haven't seen since. He actually sought me out and got in touch with me, which was awesome. It's great to see people you haven't seen in so long, especially old friends!
Another cool thing was Barrack Obama's nomination acceptance speech. I don't want to make this too political because arguing politics is kind of futile and time is at a premium for me now days, but I'd like to add the disclaimer that I am a local campaign volunteer and I have decided to support Obama. I don't agree with everything he says , but I love his vision and passion. I'm an independent voter, relatively moderate with a slight left bias, and I actually admire John McCain. To cut to the chase, Obama's speech Thursday night, which was well past my bed time thanks to the whole stupid mountain time zone thing, literally blew me away. If you don't feel a little inspired after this speech, then I don't know what to say. If you have some free time this weekend, and you haven't seen the speech I encourage you to put aside your political biases for a bit, take some time out and see it. You can check the speech out here.
If you haven't thought about the election yet, check out the candidates' websites and read up on their policies. I also encourage you to play nice and be respectful of others' opinions. As much as the media may focus on pointless issues like Obama's religion or McCain's 7 houses, I think that on a whole Americans have two good nominees.
Have a safe and happy Labor Day Weekend!
Friday, August 29, 2008
Tuesday, August 19, 2008
Real Science
Block 1, "Becoming a Doctor," ended last Friday after our 5 hour-long Summative Synthesis Essay Questions (SSEQs). Basically this is a flashy way of saying we had a long ass test consisting of four essays. Overall I thought the test well. I wrote too much for many of the essays and I think my answers were kind of verbose and perhaps somewhat peripheral to the questions. We had one question asking us to describe how the poverty-gap, which is worse in the US than other developed nations, affects the health of the poor. Granted the question was politically charged to begin with, I ended up writting about supply-side economics and how public health funding is affected by fiscal policy. I am in medical school, right? I think it's safe to say we all passed, but we won't know for sure until tomorrow when we receive our feedback.
This week is when med school, in the traditional sense, really begins. Block 2 is called "The Human Blueprint." During this 11 week block we learn primarily about genetics and development. I think genetics is interesting, but I can honestly tell you that the material is out of my comfort zone. I am comfortable with molecular genetics, to an extent, especially with regards to pharmacology and biochemistry. There is still a bunch of other stuff that I am not comfortable with including patterns of inhertience, karyotypes and all the "big picture" genetic issues. Show me a nucleotide structure and I will feel at home. Talk about chromosomal abnormalities and I will freak out.
I might just be overreacting a bit because frankly, I am kind of overwhelmed right now. Every day we seem to have a ton of reading and things we need to go over. It's easy to get lost in detail and lose focus of clinically relevant concepts. I probably know more about genetics than what I give myself credit for, or so I hope.
Speaking of being overwhelemed, this week really is brutal: Instead of having our normal IQ groups, we have a ton of lecture, since this is the first week of the block and we're supposed to be getting acclimated to the new material. For once, I kind of don't mind the lectures since it's nice to have all random details focused into core concepts, but I can see it getting old real fast. I am looking forward to IQ and getting underway with new cases next week. Also during this block, we begin to learn about performing a routine physical exam. We get to practice on each other and standardized patients. It should be good times.
I know it's only been two days, but this basic science is kind of killing me. For one, I am in the small minority that misses public health. Luckily for me I'm taking an MPH class (and seminar, and working on my capstone-albeit at a snails pace) starting this Monday. The class is on mental health epidemiology and it should be interesting. Second, ever since I got to intubate that mannequin, I am really itching to get back to some EMS fun. I was contemplating signing up for one elective to spend 2 hours each week at Metro ER to shadow a doc and learn some procedures. I'm probably going to hold off on this for a bit and see how my schedule falls into place first. It's too easy to commit to activities around here.
In other news, the weather up here in Cleveland has been awesome lately. I came back home from school at around 8:30 pm today and it was actually kind of crisp outside-it feels like fall. I like the fall because it means 1.) football and 2.) greens fees at golf courses will go down soon. It's too bad the best weather of the year has to be when school starts up and I start to get swamped. Oh well.
This week is when med school, in the traditional sense, really begins. Block 2 is called "The Human Blueprint." During this 11 week block we learn primarily about genetics and development. I think genetics is interesting, but I can honestly tell you that the material is out of my comfort zone. I am comfortable with molecular genetics, to an extent, especially with regards to pharmacology and biochemistry. There is still a bunch of other stuff that I am not comfortable with including patterns of inhertience, karyotypes and all the "big picture" genetic issues. Show me a nucleotide structure and I will feel at home. Talk about chromosomal abnormalities and I will freak out.
I might just be overreacting a bit because frankly, I am kind of overwhelmed right now. Every day we seem to have a ton of reading and things we need to go over. It's easy to get lost in detail and lose focus of clinically relevant concepts. I probably know more about genetics than what I give myself credit for, or so I hope.
Speaking of being overwhelemed, this week really is brutal: Instead of having our normal IQ groups, we have a ton of lecture, since this is the first week of the block and we're supposed to be getting acclimated to the new material. For once, I kind of don't mind the lectures since it's nice to have all random details focused into core concepts, but I can see it getting old real fast. I am looking forward to IQ and getting underway with new cases next week. Also during this block, we begin to learn about performing a routine physical exam. We get to practice on each other and standardized patients. It should be good times.
I know it's only been two days, but this basic science is kind of killing me. For one, I am in the small minority that misses public health. Luckily for me I'm taking an MPH class (and seminar, and working on my capstone-albeit at a snails pace) starting this Monday. The class is on mental health epidemiology and it should be interesting. Second, ever since I got to intubate that mannequin, I am really itching to get back to some EMS fun. I was contemplating signing up for one elective to spend 2 hours each week at Metro ER to shadow a doc and learn some procedures. I'm probably going to hold off on this for a bit and see how my schedule falls into place first. It's too easy to commit to activities around here.
In other news, the weather up here in Cleveland has been awesome lately. I came back home from school at around 8:30 pm today and it was actually kind of crisp outside-it feels like fall. I like the fall because it means 1.) football and 2.) greens fees at golf courses will go down soon. It's too bad the best weather of the year has to be when school starts up and I start to get swamped. Oh well.
Tuesday, August 12, 2008
Exam Week
This week is weird. It kind of feels almost like what finals week would feel like back at Rice, the only difference is I'm not pulling all-nighters culminating with breakfast at Taco Cabana at 5 AM. To all my Rice people: you don't know how much I miss TC. It's probably a good thing I came back home for school though, since I end up eating home cooked meals which are quite healthy, not to mention delicious.
The first thing I noticed this week was how short our IQ case was. This week we're discussing medical errors. Tomorrow our group reconvenes and discusses the learning objectives we formulated on Monday. Somehow I doubt we'll spend the entire two hours talking about medical errors.
Today was especially strange since it felt like public health classes all over again, just a bit angrier. Yes, I said angrier: I'll explain. Just to summarize for my friends out there scattered throughout the world, basically, the entire medical school class is split into 20 different IQ groups. While we discuss cases in our IQ groups, during this first block we also worked on a population health descriptive statistics project where we were assigned to learn more about health indicators in a specific Cleveland neighborhood. Today, each IQ group presented their findings in medium group settings of 4 IQ groups/room.
When I walked in my group's assigned room this morning, my day become about 50x better since I saw my MPH program advisor and capstone chair sitting in the front. For those of you who don't know him, Mendel (professionally referred to as Dr. Singer, but he'd rather be called Mendel) is awesome. He's this goofy and nerdy orthodox Jewish guy with this crazy beard. He has 8 kids! He pretty much taught me everything I ever need to know about biostats and most recently cost-effectiveness analysis. I also learned a lot about medicine from him..ok maybe not. But if you go into his office sometime, he has a little game called "med school in a box." Check it out-you'll find it hilarious. Also, don't be offended if he makes fun of you for being a med-student. As a Ph.D statistics/policy-type person, he considers himself a "real-doc." Whatever.
Our presentation went well, and I thiought the other presentations were good too. Afterwards, was when all the fun started.
I think what makes Mendel such a great teacher is his willingness to ask for student feedback and use that to continuously improve his teaching. After our presentations were over he asked for feedback regarding the project. To be blunt, shit hit the fan.
I think it was pretty unanimous that most people were unhappy with the project. Basically it was an exercise in descriptive statistics which many people found ambigous, without sufficient context, and of little clinical relevance. Part of Mendel's job I guess, is to take all this feedback and give it to our block leader, who came up with the project idea (who is a great guy, albeit opinionated, controversial and somewhat disorganized which is unfortunately leading to his continued unpopularity among students).
Personally, I wasn' too thrilled with the project. First of all, I was frustrated that I had to mess with NEOCANDO data when I have my own database of research info that I need to manipulate for my MPH capstone (in fact I shouldn't be writing this blog right now, I need to be working on MPH stuff...). Second, the ultimate goals and expectations of the project were not made clear, and I think that is what also contributed to a lot of frustration. Finally, even after we get all these population health trends, we have to ask our-selves: as future physicians what can we do to change things? As we talk about macroscopic determinants of health I continue to question the physician's role in society. There is so much more I want to read/write/discuss about with regards to health policy, politics and ethics. I won't bore you with these posts now, but I will later. In fact, one of my friends (Gabriel Valle) and I are thinking of setting up another blog to consdier some of these issues to help spur a bit more dialouge.
The session after our presentations regarded our behavioral health projects, where each member of the class was challenged to meet the goal of walking 10,000 steps/day. There was also a lot of interesting feedback regarding this challenge which I will touch on in later posts. I easily get 10,000 steps a day. Actually, that's a lie. I really only take about 2000 steps a day, but if you consider my early morning workouts and converted the exercise into steps, then I'd easily cross 10,000. The only problem is when I'm so committed to my workouts already, the last thing I remember is to convert the numbers into steps and enter them online. Oops. Needless to say, I didn't win any prizes today.
In the afternoon we had buddy lunch. Basically each first year student is matched with a second year student as a mentor. My buddy is awesome. He gave me a lot of good heads-up info for the block to come. He's even letting me use one of his textbooks from last year. Hopefully I'm not sufficiently jaded and overworked to be a friendly buddy for some (un)lucky MS1 next year.
After an hour or so studying some epidemiology a couple friends and I went over to an activities fair where a bunch of extra-curricular clubs set up tables to talk a bit more about their respective groups. In the end I signed up for four interest groups. Psychiatry interest group: duh, it's kind of sad though only about 4 people signed up. Neurology interest group: neuroscience is cool. Emergency Medicine interest group: I kind of miss EMS, so why not? Anesthesiology interest group: wtf? Ya, to be honest I'm really not that interested in anesthesiology (to be fair, right now I'm not interested in it). Something about prepping people for surgery and pretty much being their lifeline while some guy cuts them open just scares me. Nevertheless, I still felt compelled to join. You see, they had this mannequin out on the table. As I walked by I saw a 4th year trying to explain to one of my first year classmates how to intubate. I immediately thought back to Rice EMS and the fun we had doing speed intubations on mannequins. I jumped in and played around for about 5 minutes, intubating the damn thing about a dozen different times. I think the 4th year kind of looked at me the whole time and thought I was crazy. It was therapeutic. Don't ask.
I spent the rest of the afternoon/early evening studying for the exam. I came home, mowed the lawn, played with the dogs, and here I am rambling away. Good times. I'll need to focus a bit harder tomorrow and make sure I have my material down cold. I'll write again after the exam.
The first thing I noticed this week was how short our IQ case was. This week we're discussing medical errors. Tomorrow our group reconvenes and discusses the learning objectives we formulated on Monday. Somehow I doubt we'll spend the entire two hours talking about medical errors.
Today was especially strange since it felt like public health classes all over again, just a bit angrier. Yes, I said angrier: I'll explain. Just to summarize for my friends out there scattered throughout the world, basically, the entire medical school class is split into 20 different IQ groups. While we discuss cases in our IQ groups, during this first block we also worked on a population health descriptive statistics project where we were assigned to learn more about health indicators in a specific Cleveland neighborhood. Today, each IQ group presented their findings in medium group settings of 4 IQ groups/room.
When I walked in my group's assigned room this morning, my day become about 50x better since I saw my MPH program advisor and capstone chair sitting in the front. For those of you who don't know him, Mendel (professionally referred to as Dr. Singer, but he'd rather be called Mendel) is awesome. He's this goofy and nerdy orthodox Jewish guy with this crazy beard. He has 8 kids! He pretty much taught me everything I ever need to know about biostats and most recently cost-effectiveness analysis. I also learned a lot about medicine from him..ok maybe not. But if you go into his office sometime, he has a little game called "med school in a box." Check it out-you'll find it hilarious. Also, don't be offended if he makes fun of you for being a med-student. As a Ph.D statistics/policy-type person, he considers himself a "real-doc." Whatever.
Our presentation went well, and I thiought the other presentations were good too. Afterwards, was when all the fun started.
I think what makes Mendel such a great teacher is his willingness to ask for student feedback and use that to continuously improve his teaching. After our presentations were over he asked for feedback regarding the project. To be blunt, shit hit the fan.
I think it was pretty unanimous that most people were unhappy with the project. Basically it was an exercise in descriptive statistics which many people found ambigous, without sufficient context, and of little clinical relevance. Part of Mendel's job I guess, is to take all this feedback and give it to our block leader, who came up with the project idea (who is a great guy, albeit opinionated, controversial and somewhat disorganized which is unfortunately leading to his continued unpopularity among students).
Personally, I wasn' too thrilled with the project. First of all, I was frustrated that I had to mess with NEOCANDO data when I have my own database of research info that I need to manipulate for my MPH capstone (in fact I shouldn't be writing this blog right now, I need to be working on MPH stuff...). Second, the ultimate goals and expectations of the project were not made clear, and I think that is what also contributed to a lot of frustration. Finally, even after we get all these population health trends, we have to ask our-selves: as future physicians what can we do to change things? As we talk about macroscopic determinants of health I continue to question the physician's role in society. There is so much more I want to read/write/discuss about with regards to health policy, politics and ethics. I won't bore you with these posts now, but I will later. In fact, one of my friends (Gabriel Valle) and I are thinking of setting up another blog to consdier some of these issues to help spur a bit more dialouge.
The session after our presentations regarded our behavioral health projects, where each member of the class was challenged to meet the goal of walking 10,000 steps/day. There was also a lot of interesting feedback regarding this challenge which I will touch on in later posts. I easily get 10,000 steps a day. Actually, that's a lie. I really only take about 2000 steps a day, but if you consider my early morning workouts and converted the exercise into steps, then I'd easily cross 10,000. The only problem is when I'm so committed to my workouts already, the last thing I remember is to convert the numbers into steps and enter them online. Oops. Needless to say, I didn't win any prizes today.
In the afternoon we had buddy lunch. Basically each first year student is matched with a second year student as a mentor. My buddy is awesome. He gave me a lot of good heads-up info for the block to come. He's even letting me use one of his textbooks from last year. Hopefully I'm not sufficiently jaded and overworked to be a friendly buddy for some (un)lucky MS1 next year.
After an hour or so studying some epidemiology a couple friends and I went over to an activities fair where a bunch of extra-curricular clubs set up tables to talk a bit more about their respective groups. In the end I signed up for four interest groups. Psychiatry interest group: duh, it's kind of sad though only about 4 people signed up. Neurology interest group: neuroscience is cool. Emergency Medicine interest group: I kind of miss EMS, so why not? Anesthesiology interest group: wtf? Ya, to be honest I'm really not that interested in anesthesiology (to be fair, right now I'm not interested in it). Something about prepping people for surgery and pretty much being their lifeline while some guy cuts them open just scares me. Nevertheless, I still felt compelled to join. You see, they had this mannequin out on the table. As I walked by I saw a 4th year trying to explain to one of my first year classmates how to intubate. I immediately thought back to Rice EMS and the fun we had doing speed intubations on mannequins. I jumped in and played around for about 5 minutes, intubating the damn thing about a dozen different times. I think the 4th year kind of looked at me the whole time and thought I was crazy. It was therapeutic. Don't ask.
I spent the rest of the afternoon/early evening studying for the exam. I came home, mowed the lawn, played with the dogs, and here I am rambling away. Good times. I'll need to focus a bit harder tomorrow and make sure I have my material down cold. I'll write again after the exam.
Thursday, August 7, 2008
Jail, Blue Toes and Stethoscopes
I want to start off by thanking everyone who took the time to respond to my post either online or in-person last week. I'm simply amazed that people actually read what I have to say. It's gratifying. It seems like this blogging thing is becoming a weekly affair. I want to write more, but it's getting kind of tough, especially with this MPH work I'm trying to get out of the way before the "real science" hits. In the future I'll try having new posts every Monday and Thursday.
The theme of this week, per block 1 faculty leaders, has been health inequities. In our IQ groups (small groups) our case has centered around STDs. As part of our learning experience we had the opportunity to head out into the community to learn more about HIV/AIDS. I was paired with one of my friends to head out to the county jail in downtown Cleveland (seriously, there is a jail directly across from the Browns Stadium!).
Care Alliance, a federally funded medical care center for the indigent population conducts public health research regarding medical care seeking behavior among HIV positive inmates upon their release from jail. Basically, I had the opportunity to shadow one of the researchers during her interview with an inmate. I had the opportunity to chime in and talk with the inmate during this time.
I got to know Steve pretty well. He is 29 and has been a crack addict for the last 20 years. Do the math. He's also done pretty much every other drug on this planet. Steve has a high school education and has been homeless the last decade. His family has pretty much shunned him from their lives and he was basically free to roam the streets and make money as a sex worker. Five years ago he was hospitalized to undergo surgery for pericarditis. The surgery was successful, but the experience was life changing. As he was resting upon completion of the operation, he was told of his HIV status. Awesome.
Five years later after some petty theft he's in jail on a cloudy day sharing his sensitive life story with some random "kiddie-doc" Indian student from the suburbs. What I haven't told you yet was how smart Steve is. Apparently he picked up Spanish and sign language while on the streets. He elaborately explained to me the concept of a secondary immune response. He also relayed to me his knowledge of 2nd generation atypical antipsychotic and their neurochemical effects. Wow. How did this guy ever end up on the streets and get to where he is?
It was pretty obvious in my time interviewing him that Steve had some serious emotional health concerns. His ADHD was blatantly obvious. He was frustrated at himself and at the system. He acknowledge that he needs help, but he's also angry at his family for not supporting him. Moreover, he's angry at himself for letting the people who were in his life, down. Apparently psychiatric care in jails consists of pill-pushing with minimal to no psycotherapy. I think all Steve wanted was to talk to someone. I could tell after sometime he felt a bit relieved to get his thoughts off his chest as he was really looking forward to scheduling a follow-up meeting with the researcher. His psychological concerns were compounded by the fact that his viral load has worsened over the course of his stay. He thinks he might have to start some treatment for his HIV soon. He probably should.
I became really interested in correctional and forensic psychiatry after my time at the jail. It just amazes me how addiction and emotional concerns are brushed aside. Aren't these supposed to be "correctional" facilities? How can you "correct" someone if you just have them take some antidepressants and their best medical care is some doctor on a television screen evaluating them from 200 miles away in Columbus? Perhaps if he saw a child psychiatrist at age 9, his life might have turned out different? Perhaps, not? My questions and insight are kind of premature based on this one experience, but I'm interested in learning more. It's kind of funny that I think of his HIV as an afterthought to his psychiatric problems, seeing as the purpose of the trip was to learn more about living with HIV. Really though, I don't think the emotional and physical components of the disease can be separated. They really are intertwined.
School this week has been pretty solid for the most part. Lectures have been boring, but the IQ group discussions have been good. Our final communications seminar, which was a synthesis of all the skills we've learned so far, went well. My IQ group took a field trip to our neighborhood in Cleveland which we are doing our population health project on. The neighborhood, South Broadway, is basically south of downtown and consists of the old Slavic village. It's kind of run down, but pretty much an average Cleveland neighborhood. They have a pretty cool ice cream place. I recommend the black walnut.
There were only two things this week which kind of sucked. First, my big left toe is bruised. I think this came as a result of my overly active kind of stupid and crazy weekend. First, I played several intense games of pick-up basketball last Friday. This is probably where most of the damage happened. I then played 9 holes of golf immediately after the basketball. After that I went swimming for an hour. The next afternoon I walked 18 holes of golf. On Sunday morning I rode the exercise bike for 20 minutes, played a quick 15 minute pick up game with the old-timers at the racquetball club and played another 18 holes of golf in the evening, but I rode a cart that time instead. The good news was I shot an 81, and I very well could have broke 80 had I not been stupid on two of the holes.
As a result of my being young and stupid, I limped around school the last several days. I wrapped my toe up with some tape yesterday and it feels much better now. I'm going to try to take it a bit easy this weekend (though I must get my Friday basketball in-it's a must). Not to mention, next week we have our block 1 exam, so I'll need some down time to study anyway.
The other thing this week, which was not fun, was purchasing a stethoscope. I never realized that picking a scope would be so time-consuming and nerve wrecking. I was torn between two particular types, but I ended up picking the one made of "trumpet brass and chrome." Yes, my stethoscope has chrome. I feel so special.
The theme of this week, per block 1 faculty leaders, has been health inequities. In our IQ groups (small groups) our case has centered around STDs. As part of our learning experience we had the opportunity to head out into the community to learn more about HIV/AIDS. I was paired with one of my friends to head out to the county jail in downtown Cleveland (seriously, there is a jail directly across from the Browns Stadium!).
Care Alliance, a federally funded medical care center for the indigent population conducts public health research regarding medical care seeking behavior among HIV positive inmates upon their release from jail. Basically, I had the opportunity to shadow one of the researchers during her interview with an inmate. I had the opportunity to chime in and talk with the inmate during this time.
I got to know Steve pretty well. He is 29 and has been a crack addict for the last 20 years. Do the math. He's also done pretty much every other drug on this planet. Steve has a high school education and has been homeless the last decade. His family has pretty much shunned him from their lives and he was basically free to roam the streets and make money as a sex worker. Five years ago he was hospitalized to undergo surgery for pericarditis. The surgery was successful, but the experience was life changing. As he was resting upon completion of the operation, he was told of his HIV status. Awesome.
Five years later after some petty theft he's in jail on a cloudy day sharing his sensitive life story with some random "kiddie-doc" Indian student from the suburbs. What I haven't told you yet was how smart Steve is. Apparently he picked up Spanish and sign language while on the streets. He elaborately explained to me the concept of a secondary immune response. He also relayed to me his knowledge of 2nd generation atypical antipsychotic and their neurochemical effects. Wow. How did this guy ever end up on the streets and get to where he is?
It was pretty obvious in my time interviewing him that Steve had some serious emotional health concerns. His ADHD was blatantly obvious. He was frustrated at himself and at the system. He acknowledge that he needs help, but he's also angry at his family for not supporting him. Moreover, he's angry at himself for letting the people who were in his life, down. Apparently psychiatric care in jails consists of pill-pushing with minimal to no psycotherapy. I think all Steve wanted was to talk to someone. I could tell after sometime he felt a bit relieved to get his thoughts off his chest as he was really looking forward to scheduling a follow-up meeting with the researcher. His psychological concerns were compounded by the fact that his viral load has worsened over the course of his stay. He thinks he might have to start some treatment for his HIV soon. He probably should.
I became really interested in correctional and forensic psychiatry after my time at the jail. It just amazes me how addiction and emotional concerns are brushed aside. Aren't these supposed to be "correctional" facilities? How can you "correct" someone if you just have them take some antidepressants and their best medical care is some doctor on a television screen evaluating them from 200 miles away in Columbus? Perhaps if he saw a child psychiatrist at age 9, his life might have turned out different? Perhaps, not? My questions and insight are kind of premature based on this one experience, but I'm interested in learning more. It's kind of funny that I think of his HIV as an afterthought to his psychiatric problems, seeing as the purpose of the trip was to learn more about living with HIV. Really though, I don't think the emotional and physical components of the disease can be separated. They really are intertwined.
School this week has been pretty solid for the most part. Lectures have been boring, but the IQ group discussions have been good. Our final communications seminar, which was a synthesis of all the skills we've learned so far, went well. My IQ group took a field trip to our neighborhood in Cleveland which we are doing our population health project on. The neighborhood, South Broadway, is basically south of downtown and consists of the old Slavic village. It's kind of run down, but pretty much an average Cleveland neighborhood. They have a pretty cool ice cream place. I recommend the black walnut.
There were only two things this week which kind of sucked. First, my big left toe is bruised. I think this came as a result of my overly active kind of stupid and crazy weekend. First, I played several intense games of pick-up basketball last Friday. This is probably where most of the damage happened. I then played 9 holes of golf immediately after the basketball. After that I went swimming for an hour. The next afternoon I walked 18 holes of golf. On Sunday morning I rode the exercise bike for 20 minutes, played a quick 15 minute pick up game with the old-timers at the racquetball club and played another 18 holes of golf in the evening, but I rode a cart that time instead. The good news was I shot an 81, and I very well could have broke 80 had I not been stupid on two of the holes.
As a result of my being young and stupid, I limped around school the last several days. I wrapped my toe up with some tape yesterday and it feels much better now. I'm going to try to take it a bit easy this weekend (though I must get my Friday basketball in-it's a must). Not to mention, next week we have our block 1 exam, so I'll need some down time to study anyway.
The other thing this week, which was not fun, was purchasing a stethoscope. I never realized that picking a scope would be so time-consuming and nerve wrecking. I was torn between two particular types, but I ended up picking the one made of "trumpet brass and chrome." Yes, my stethoscope has chrome. I feel so special.
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