Author: Angela Marie DelPrete

Angela DelPrete is a first-year medical student at the University of Central Florida College of Medicine. She graduated from the Burnett Honors College at the University of Central Florida with a B.S. in Molecular Biology and Microbiology and minors in Italian and Spanish. Her current research includes a four-year study on the preservation of medical student empathy and she aims to publish at the completion of her medical school career. In her "spare time" she enjoys exploring Lake Nona on her bicycle or snuggling up with a cup of tea and a paperback.

Poetry

Studying on a Sunday

I love the way your quadriceps twitch beneath the table,
awakening your patella
and asking your damaged collateral ligaments if they are feeling any stronger today.
And I love how the curvature of your corneas focuses light just before it reaches your retina,
weakening your long-distance sight
and giving me another excuse to come closer.
I love the thickened areas of stratum corneum on your palms,
summoned from layers below each time you reach for a wrench,
and how they grip onto my epidermis each time you reach for my hand.
I love the way you manipulate your vocal cords and adjust the curve of your tongue
to effortlessly transform the air in your lungs into the sweetest “Good morning,”
and how your right lateral incisor proudly stands just a slight bit forward from the rest of your smile,
and how the collection of melanocytic nevi on your skin connects to form a crescent moon,
or an elephant, or train tracks,
depending on how the neurons in my brain direct my imagination that day.
I love the way your closed fist is pressed against the angle of your mandible,
supporting your head and all the vessels that travel through the delicate tunnels within your neck
that converge as they greet the heart I loved from day one.

Featured image:
Love is not Blind

Tags love

Clinical Narrative Reflection

On ICU Rounds

Passing through the restricted entrance of the ICU is like stepping foot into another dimension.

A web of clear and blue plastic tubes makes it nearly impossible to determine which machine is wildly wailing as you enter this strange environment. Few patients are conscious. Some might argue that few are truly alive. Passing by rooms with no visitors is depressing but a crowd of family members in a doorway may just choke you up.

I knew I was in a fragile state, at the mercy of sharp memories of previous trips to the ICU, where my own family members shared the same lifeless gaze of each patient that was now before me.

Torn between my current emotional state and desire to learn all I could about the patient on whom our team was currently rounding, I stood between the IV stand and my preceptor as he discussed the course of action with the nurse and me. I was part of the team, part of the conversation, part of the solution. I was in the moment. It was exhilarating.

After discussing our treatment plan, my preceptor and the nurse left the room and I suddenly found myself alone with the patient. I was no longer part of a conversation. I was in a different moment. I was simply an observer that might as well have been family. This patient was no longer a forgettable name on a chart. He was a father, possibly a brother, certainly a son. The poor chances of survival that my preceptor had mentioned earlier echoed in my ears, as I watched the green peaks and troughs dance on his heart monitor. I wondered when he had last opened his eyes, and I wondered who he last saw with them. I no longer felt like the powerful problem-solving medical student that I was just minutes before.

As I stood silently next to the patient, I contemplated a recurrent source of anxiety: the desire to enter into a field of medicine with constant variety and endless excitement, and the potential for high levels of emotional stress. It was then that I realized the subtle yet poignant experience that had just occurred: in the moment, I thrived. I recognized the importance of logical discourse in the treatment of this man, and I was able to focus on the task of caring for our patient. As soon as the tethers of responsibility had been cut and I was free to feel, I felt. The ability to compartmentalize heavy emotions is a necessary skill in the practice of medicine and one that paves the way for balance between successfully caring for our fellow humans and remaining one ourselves.

I proceeded to meet my preceptor outside, bursting at the seams with questions regarding our patient’s condition. Back in the moment. Cool as a cucumber.

And I cried the whole way home.

Featured image:
to much food by wolfgangphoto

Tags compartmentalization, emotions, intensive care unit

General

On Hope

The day’s clinical case presented in anatomy lab was that of a 40-year-old male who had dislocated his sixth cervical vertebrae in a surfing accident. Upon arrival at the hospital, he had suffered full paralysis from the neck down but was still conscious and alert. He and his wife were told that surgery would be needed to repair his broken neck, but that the chances were very slim that he would ever regain the functions he had lost due to the injury. The last page of the case was an X-ray image of the man’s vertebrae fused with screws and plates realigning his spinal cord. His prognosis was left to the students’ speculation. We returned to the classroom to debrief the case.

As a group, we discussed the grim injury in all of its anatomic and physiologic glory. Guest surgeons explained the gravity of the man’s situation and the devastating symptoms with which he presented. The case ended as they all do: we hoped for the best for our fictional patient but understood the assumed permanence of an injury of this type.

There was a long pause before Dr. Payer said, “Would you like to meet him?”

Shocked, we all turned to the back of the room where Dr. Topping was opening the door for our patient – would he be in an electric wheelchair? Would his body appear atrophied and weak from years of paralysis? How would he get down the steps in our classroom?

A strong, unfamiliar voice echoed from the front of the classroom. “Hi, everyone.”

We turned around to see who could be distracting us from seeing our patient come through the door. It did not take long for us to all realize that the man standing before us on two perfectly healthy legs, holding a microphone with two fully-functioning hands, with zero sign of ever having suffered a devastating cervical subluxation, was our patient. All 120 of us gasped in unison. It was an incredible sight, an absolute medical miracle. When you spend your days studying everything that goes wrong with the human body, it is amazing to see something that went right−the experience had me in tears.

He filled in all the gaps of the case and explained the details of his injury and his recovery. He talked about his physicians and surgeons and how he had ran the Turkey Trot just two months after his accident. Then, his best friend who happened to be a physician at the hospital to which he was flown told us the most important factor in his return to normalcy: when everyone else had lost hope, he never did. He refused to accept a prognosis of permanent paralysis. He refused to accept the possibility of an unsuccessful surgery. He never gave up on his body, so his body never gave up on him.

This story is, of course, rare. And yet, it speaks volumes about the power of the human spirit. As a medical student, I will be one of the last people to refuse credit to the nurses, physicians, paramedics, and surgeons who undeniably saved this man’s sense of a normal life. But I also know firsthand what happens when you give up. Keeping hope does not mean you automatically win the battle. But the alternative guarantees a loss.

It is a concept that I have been battling with since I began medical school. As a pre-medical undergraduate student, I had nothing but the utmost confidence in myself. I saw myself receiving my white coat. I saw myself as a doctor. Of course, I had my doubts – especially around application season. But even on my darkest days, I knew I could get to medical school. I made it, and in the process, have lost all confidence in myself. I feel as though I am the only one who does not believe in my ability to succeed. I feel like a fake, an imposter; as though I’m floating through a movie scene just waiting for someone to yell “CUT!” Perhaps it is because the next step is actually being a doctor. The next step no longer involves passing a module exam and meeting research deadlines. The next step involves real people, real families, real life, and real death.

And yet, I could not feel more at home. There is really no place else I would rather be. But I still fall asleep every night to a lullaby of forced distraction as my mind tries to convince me that I cannot do it, that I will not make it through, and that everyone else has such a better handle on life than do I. And once you lose hope, no amount of distraction can help you fall asleep. Give up on your mind, and it will give up on you.

Featured image courtesy of Mark H. Anbinder

Narrative Reflection

On Anatomy Lab

Photo courtesy of UC Davis School of Medicine

For a medical student, anatomy lab is a rite of passage.

Everything about it is a test: Can you withstand the sharp sting of formaldehyde at 8 AM? Can you differentiate between the vagus and the phrenic nerves? Can you delicately dissect the muscles of the forearm?

Can you make that first cut?

Human emotion fascinates me and my psyche just so happens to be a complex, peculiar, and interesting specimen to study. The psychological effects of working in the anatomy lab had a profound impact on me, even with scalpel in hand two months after my first day. Day one of lab went just as I had anticipated: I kept my cool until someone broke my composure by casually asking how I was doing. I fought back tears after the harmless inquiry until I could isolate myself and let it all out in a corner between a large window and a countertop covered in plastic model brains. I had been trying to make a positive first impression on my lab group by keeping a composed demeanor despite being in an environment worthy of vast displays of emotion. Clearly, this was no simple task. Although mixed with a bit of embarrassment, I immediately felt relief upon the crumbling of the emotional dam that I had worked so hard to build. I would have stayed in the corner longer to release all of the fear, sadness, and confusion had I not felt so guilty about leaving my group within the first five minutes of lab. I typically use distraction techniques to rid myself of negative thoughts but the impending return to the lab table invalidated those tricks. Instead, I accepted that I had nothing to be embarrassed about, that I could sort through my feelings on my bike ride home, and that it is okay to let my classmates see me cry. One deep, cleansing breath later, I rejoined my group and together we embarked on our seventeen-week journey.

After that episode, I dreaded returning to the chilled tank that housed the body of a woman who could have been my mother: same age, same surgical scars, same body type. In the seven-day interim, I pondered her life. I wondered about her family, where she had worked, what made her choose to donate her body. I wondered if she died in peace or in pain. I thought about the people in my life who had passed away. Each of their deaths was sudden, painful, unanticipated, and unjustified, and left me with an incredibly significant sadness. I wondered if my perspective on death was natural, if it was normal for me to feel such heartache in the presence of a deceased stranger. I eventually concluded that there is no perfect answer because there is no norm by which to judge my perspective. With that understanding, I made peace with my emotions.

My sadness subsided over the subsequent weeks as I found myself head-over-heels in amazement and respect for the human body. I felt like a pilgrim finally reaching a sought-after shrine, seeing for the first time with my own eyes the conglomerate of vessels, nerves, organs, and muscles that until then I had only ever read about. Despite the body’s collective complexity, the individual parts seemed unbelievably simple and incapable of carrying out the multitude of physiological functions required for life.

As we uncovered one pathologic finding after another in our hunt to determine our cadaver’s cause of death, I began to involuntarily formulate a mental scenario of this woman’s final years, months, and even the day she died. Soon enough, each physical finding that suggested a potential cause of her death was accompanied by an imagined reproduction of her life. One half of me was determined and anxious to uncover new pathology that might lead to a stronger differential and the other half wished it could painlessly declare natural causes. In the histology lab, I encountered yet another emotional challenge. One minute I was eagerly anticipating visible signs of liver metastasis and the next I was welling up behind the eyepiece of my microscope, imagining our young patient receiving the news that she had five months to live.

No two medical students have the same anatomy lab experience. For me, the past nine weeks have altered my view of death and further sensitized me to human suffering. Death no longer seems personal, but rather a fundamental biologic process. It is the suffering that often precedes death that has consumed me as an anatomy student. Death undoubtedly brings about a suffering all its own—which was my initial source of heartache at the beginning of lab season. Who did this woman leave behind? Are they still grieving over her passing? But as we uncovered her countless medical problems, I wondered what was harder for her family and friends: to live with her absence, or to live with her suffering?

When it comes to anatomy lab, many medical students would express that there is nothing to it — it is simply another requirement. For others, it is unashamedly so much more. It is said that the cadaver is the medical student’s first patient. I only wish I had the opportunity to thank mine.

Featured photo courtesy of UC Davis School of Medicine