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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Contributors
Boston Globe Health and Science staff:
Scott Allen
Alice Dembner
Carey Goldberg
Liz Kowalczyk
Stephen Smith
Colin Nickerson
Beth Daley
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
 Short White Coat blogger Ishani Ganguli
 Short White Coat blogger Jennifer Srygley
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Thursday, November 1, 2007

Short White Coat: Decisions, decisions

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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On Tuesday night, I witnessed a near-riot -- during yet another class meeting to explain how weíll be affected by the med schoolís new curriculum.

In the next two weeks, weíll have to rank our choices for the hospital where weíll spend almost all of our waking and sleeping hours in our third year of medical school. Though recent pilot programs have tested out the so-called longitudinal approach to our clinical training (read: spend the year in one hospital instead of several), it will be required for the first time for the class of 2010. This translates into what would seem an important choice.

But any merits of the new plan aside, the administration managed to ruffle some feathers in communicating this information to us.

Students clamoring for information about what to expect while faculty seemingly don't want to ruin the surprise -- itís been a bit of a theme ever since the curriculum was unveiled last fall. This time, we were left wondering how to make the decision, and whether it even mattered in the first place.

For Tuesdayís meeting, we packed into our familiar lecture hall, plied with Sicilian pizza and bottled water. The event began unpromisingly, with a PowerPoint slide explaining how the changing practice of medicine -- and not the ďotherwise excellentĒ HMS system -- should be blamed for any grievances we might have with our third year. We heard the usual curriculum buzzwords like integrative and multidisciplinary, and were presented with impossibly quantitative demonstrations of how they planned to ďmake our lives palatableĒ in the coming year.

The crowd was soon frothing at the mouth for something tangible on which to hang our decisions. We wanted to see the heads of each hospital's third-year clerkship affirm or deny the stereotypes so often heard in passing from third-year veterans -- for example, that Massachusetts General Hospital is for pre-surgery gunners who relish overnight stays, while the Beth Israel Deaconess program caters to the overly self-reflective.

But such distinctions were obfuscated by administrators who urged us to focus on the similarities between the programs and dismissed factors such as parking and geography as inconsequential. Data were thrown at us to prove that all students were happy wherever they went. Demands for pro/con lists and bullet-pointed hospital highlights were deftly sidestepped. And then they told us we had to make a decision.

(A hapless fourth-year envoy, not picking up on the palpable hostility in the air, took this moment to remind us how magical our wards experience would be, no matter where we were. Surprisingly, nothing was thrown at him.)

Near the end of the two hours, one particularly grounded hospital medical education head conceded that this issue had been anticipated in planning meetings. But the frustrations remain. Until all of our administrators sort out their mixed messages, perhaps we should just shake off this self-imposed burden of informed decision-making and embrace the bliss of random choice.

Excuse me while I find a hat to pick out of. But wait, did you just say Mass. General has parking? Itís going to be a long two weeks.

Posted by Ishani Ganguli at 04:18 PM

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Wednesday, October 24, 2007

Short White Coat: Brain at rest

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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We finished neuro (-science, -biology, -anatomy) on Friday, and though completing a three-hour, hand-numbing final exam is always cause for celebration, I'm a bit sad to see this course go. Perhaps from their intimate understanding of the human brain, or else from pure chance, our neurology professors were particularly adept at tailoring material to fit into our brains.

There was something for every learning style -- hands-on brain dissections, neatly structured case-based tutorial sessions designed to track with our increasing skill sets, and as professor David Cardozo would proudly remind us on a regular basis, numbered slides to minimize frantic shuffling through lecture notes and put our minds at ease. Cardozo -- a veteran of this course who will soon be named associate dean for graduate education, would also bring his dog Chase to lecture on occasion to keep us on our toes. Above all, there was the frequent reality check about the amount of information from this course that we'd actually retain in our careers.

One review lecture by our other course director, Bernard Chang, even went through each subsection of the nervous system with the neuroanatomist's view we had learned but would soon lose, the more simplistic but informative neurologist's view, and the general clinician's depth of neural knowledge. I watched as the slides featured successively fewer lines and silently appreciated the practical approach so often missing in our courses.

On Thursday, we finished off the class with a slideshow featuring the interesting places we'd taken our summer neuro-anatomy reading (my photo was in the White House press room). It had been a much-needed incentive to cart this reading around in the first place.
And once it was all over -- on Friday night -- we killed some brain cells to celebrate.

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Thursday, October 18, 2007

Short White Coat: Needle-stick debrief

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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Last week's needle-stick pseudo-scare has all but resolved itself. The on-call doctor never received my page, it turned out. This has happened before, and doctors at University Health Services are looking into the reasons for the miscommunication.

Ruffled by the lack of an authority figure's oversight, I picked the brains of my colleagues in training. These accidents happen fairly frequently at Harvard hospitals and elsewhere, I discovered. A friend at another medical school cited a classmate who had stuck himself twice and started prophylactic antiretroviral therapy for HIV both times, until he could be sure the needle's previous target didn't have the disease.

My first thought -- what a waste of anti-retrovirals. But we had learned that treatment within days of the exposure can prevent infection. And though the chance a needle-stick from an HIV-positive patient would actually infect the recipient is only 1 percent (it's up to 50 percent for hepatitis B and C), it isn't zero. My source-patient was not a stranger, or a patient I knew only peripherally; it was my housemate. But out of a mixture of curiosity and sense of duty, I went with her to University Health Services at lunchtime on Friday to officially report the accident and find out what we needed to do next.

We sat down with the doctor and went through the Centers for Disease Control and Prevention guidelines for post-exposure precautions. Given the fact that I was wearing gloves and that my housemate had been cleared for blood donation at the Red Cross within the last month, I decided to forego the treatment.

Though it seemed a no-brainer, it really is a personal decision, we were told. For some people, the anxiety provoked by even a tiny risk of infection may be worth the side effects and hassle of taking the meds. We each got blood tests, just in case, doubling my left arm Band-Aid count to two. At least this was good practice for next time.

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Friday, October 12, 2007

Short White Coat: I'll have what she's having (in her bloodstream)

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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I committed the ultimate medical faux pas last night -- sticking myself with a used syringe. I have yet to find out what the full extent of the precautionary repercussions will be, since Iím still waiting for the doctor on-call for blood-borne disease exposures to, ahem, call me back. But the situation doesnít seem too dire -- and on the bright side, Iíve achieved blood-sister status with one of my housemates.

Early in the evening, I decided to check out a training workshop on administering flu shots so I could help dole them out to the Boston community. This represented the first time weíd actually get to puncture a patient -- until now, weíd done talking and testing, but no treating. So, on entering the classroom, I was relieved to see a cluster of citrus fruits next to the vials and disposable needles on the table. Apparently our first bumbling efforts would be endured by inanimate objects.

After a quick primer on the mechanics of the task, we lined up to practice shooting water into our silent charges. I put on my best doctor voice, warmly asking my orange if "he" had ever been allergic to eggs and explaining to him that I was about to wipe his skin with alcohol and that he would feel a slight pinch when I inserted the needle. "Mr. Orange" received the dose with little complaint, and my only regret is that I could not offer him one of the Looney Tunes Band-Aids that motivated my strange affection for vaccine shots when I was a child.

And then it was time for The Real Thing. I modified my doctor speech slightly to address my housemate, then stuck the syringe into the vial of flu vaccine. I overcame the strangeness of piercing the flesh of a living person, and a friend no less, and plunged right in like a pro. But as I pulled out the needle and started to put on the safety cap, the needle slid abruptly into the tip of my gloved left middle finger, and it was immediately clear that this was A Bad Thing.

The nurse leading the workshop told me to wash out the tiny hole in my finger that issued small beads of blood, and to squeeze out as much of this blood as I could. She went over the risks of blood-borne pathogens, including HIV, and while I trust that my housemate is bug-free, I am to go through the usual protective steps, which in a clinical setting are probably more critical.

I paged the doctor to report my exposure like a good Clumsy-Med-Student, and following the brief flurry of activity, I let my roommate practice a shot on me. No mishaps that time around, and at least I wonít get the flu! More shortly on What to Do When You Stick a Used Needle Into Your Finger.

Posted by Ishani Ganguli at 01:54 PM

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Wednesday, October 10, 2007

Short White Coat: A Jell-O mold of the brain

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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As we head into our final weeks of neurology -- the first specialty weíve really been exposed to -- weíre starting to hear the stump speeches of doctors eager to proselytize on behalf of their chosen field.

Neurology can be as difficult as, well, brain surgery, but the field is also elegant in its simplicity, as said proselytizers are quick to remind us. Despite recent leaps in our ability to image brains, the reflex hammers and lightly probing fingertips of yesteryear still take us most of the way to a diagnosis. And neurological deficits can be picked up in the subtlest changes of a patientís gait or speech.

What does it take to fill the shoes of the gray-templed, bow-tied neurologists who guide our learning, besides a House, MD-like insight? It helps to have a knack for impersonating these subtle signs, at least when imparting the nuances to medical students. Besides being instructive, such variety shows can be entertaining -- especially on video, at two times the normal speed.

A sense of humor doesnít hurt, either (we were urged to eat a Jell-O mold of the brain as some form of early initiation to the field). Neurology must also take a particular brand of fortitude -- most diseases that affect this system are drawn out, debilitating, and irreversible.

Would I be a good fit, down the line? Itís something to think about.

Posted by Ishani Ganguli at 01:32 PM

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Thursday, October 4, 2007

Short White Coat: Race for the Snacks

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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For the past few weeks, Iíve been living off the bounty of my "altruism": Coffee, yogurt, energy bars, and soymilk from Bostonís Race for the Cure, t-shirts and fruit roll-ups from the Harvard University-wide Day of Service, and a little musical and comedic nourishment for the soul at the Boston 826 community writing center fund-raiser.

In Boston, thereís no dearth of do-good opportunities -- medical or otherwise -- and they come with more than a fair share of Free Stuff.

The Office cleverly and hilariously addressed the pageantry of charity events in its season premiere last Thursday, which featured the Michael Scott Dunder Mifflin Scranton Meredith Palmer Memorial Celebrity Rabies Awareness Fun Run Race for the Cure. Michael Scott, the ever-fumbling head honcho, urges his workers to support the rabid in a convoluted attempt to allay his guilt for hitting an employee with his car. The $700 the office raises for the spurious cause is quickly eaten up by the cost of creating a giant check (made out to ďScienceĒ) and hiring a stripper nurse to accept this check (because rabies doctors are unwilling to travel to Scranton, PA, as well as nonexistent). The perks of racing for an already existent cure? T-shirts, water, and of course, an overwhelming sense of moral contentment.

Iím getting better at rationalizing the guilt that comes with the glee of collecting charity booty. Thereís good reason for the perks -- pre-race bagels at Race for the Cure made the 5K run just a bit smoother, while spray-on pink ribbon tattoos raised awareness for the cause (at least the ones placed visibly). As for the companies donating the goods or musical acts the talent, they get good publicity out of the deal.

Iíve also been thinking more carefully about how I choose my causes. Iím happy to say that the goody bag factor is low on the list. But as a debt-ridden medical student, Iím happy to take my snacks where I can get them.

Posted by Ishani Ganguli at 03:36 PM

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Thursday, September 27, 2007

Short White Coat: Learning my 'doctoring style'

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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As we learn how to perform the neurological exam, a string of prominent lecturers stand before us and offer us the versions of these techniques that they swear by. To test peripheral vision, one neurologist always asks his patients to point to his wiggling fingers, while another flashes numbers, and so on.

Weíve been practicing elements of the exam on our classmates for a few weeks now, but last week was our first chance to test our skills on actual patients.

My charge at Massachusetts General Hospital, Mr. B, had wisps of white hair and a permanently flexed hand that made him look much older than his 52 years. A stroke had paralyzed his right side and he now lived alone with occasional visits from a nurse. Mr. B was gracious though confused, and eager to chat.

I began the exam, shining a light into his eyes while taking quick glances back at my notes. I wiggled my fingers to test his peripheral vision and made him say ahhhh, marveling at the deviated ďpunching bagĒ at the back of his throat that signaled damage in a particular nerve. But he tired quickly, I felt badly about making him uncomfortable, and after a series of botched attempts to test my increasingly alarmed patient's hearing with a tuning fork, I found myself rushing through the rest of the exam. Near the end of the allotted time, I decided that my second attempt to take his blood pressure would be my last.

In the debriefing session that followed, I presented the patientís history and my exam findings to the group: "Mr. B is a 52-year-old former smoker with chronic obstructive pulmonary disease. ..." I followed the blood pressure with the caution that it was "not well heard" -- my stab at medicalese to mean "wow, I canít believe I literally picked these two numbers at random."

My preceptor was quick to reassure me that physical exams are inherently subjective. One manís dilated pupil is another manís constricted one. Our job, she said, was to state our findings as we saw them, with little apology, and to leave room for alternative interpretations.

It was, in large part, kindness that prompted my preceptorís gross understatement. But I realized that while I fumble my way towards acquiring a standard set of skills, Iím also starting to figure out my doctoring style, pieced together from trial, error, and the wisdom of my instructors. For the first time in my training, I can make my own choice to wiggle if I want to. As for the random-number-generator method for taking blood pressure? -- not so much my style.

Posted by Ishani Ganguli at 11:15 AM

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Friday, September 14, 2007

Short White Coat: We learned that for a reason?

Short White Coat is a blog written by second-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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I'm back from a summerís hiatus from medical school -- the last weíll get until graduation. With the recent start of a second year crammed with endless classroom hours and totebags of take-home work, as well as the vaguely looming threat of next springís Board Exams, training has shifted into high gear.

Last spring, I wrote about learning how to talk to patients, how to use empathic words to connect with them and accumulate facts about their medical histories. In our second-year version of Patient Doctor class -- in which we'll actually touch and probe our guileless test patients -- we discovered this week that we need to know why we're asking each question. It's called taking an "informed history," and it requires steering the interview toward a shifting target diagnosis. If asking about a headache complaint, we must suspect migraine, tumor, or hemorrhage (among other options) and ask questions that will parse out the true cause.

Inherent in this new expectation, and in the courseload we have already undertaken in second year, is the notion that we should apply our cumulative knowledge from the past year or so. A fair demand, yes, especially since weíll be treating patients as third-year students in a matter of months. But I canít help but think I have a lot of learning -- and re-learning -- to do before I can call myself informed.

Our professors reassure us that this fear of ill-preparedness is normal at any stage of our processive march to full doctorhood. But with a year of school under my belt, I've already acquired the uneasy feeling that Iíve learned these things before, that I should know to ask if the pain always is in the same place, or if it has affected the patient's vision. No more wallowing in the ignorant bliss of first year.

Posted by Ishani Ganguli at 01:10 PM

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Thursday, August 2, 2007

Short White Coat: Physician, heal thy family

Short White Coat is a blog written by fourth-year Harvard medical student Jennifer Srygley. Her posts appear here as part of White Coat Notes. E-mail Jennifer at jen.shortwhitecoat@gmail.com.

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The phone calls started coming in even before Iíd finished one semester of medical school. As the only person in my immediate or distant family to pursue a career in medicine, I often get calls from relatives with questions about particular drugs or treatments or ailments.

They donít mean to bother me; if I were a chef, perhaps they would call to consult me about particular blends of spices. But with these phone calls, the stakes are much higher. The consequence for giving bad advice about paprika is a ruined meal, but the consequence for giving poor advice about blood pressure medication could be a heart attack.

My policy is to listen to my relativesí questions and then to help them formulate questions that they can ask their treating physician about their care. In dire situations (an incident of multiple insect stings comes to mind), I urge them to visit an emergency room. But I cannot see and observe my family members over the phone and even if I could see them, I couldnít render objective advice about their condition. For those reasons, I never give medical advice to loved ones over the phone.

I donít think my family members are unique in having many unanswered questions about their health. That they are more willing to ask an untrained medical student personal questions about their health than to call their doctor is a symptom of the larger communication breakdown in healthcare.

Many patients, my family members included, find their doctors too unapproachable or too busy to bother with small questions. But how one should adjust his insulin dosing when sick, or whether two medications can be taken together, are not small questions to the patient who needs to ask them. One of my favorite mentors in medical school always taught me to ask the patient "Is there anything else on your mind?" at least twice before leaving the exam room. Even on my busiest clinic days, I try to ask the "anything else" question and to be prepared for the full diversity of answers that follow.

Posted by Jennifer Srygley at 12:54 PM

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Wednesday, July 18, 2007

Short White Coat: To care intensively

Short White Coat is a blog written by fourth-year Harvard medical student Jennifer Srygley. Her posts appear here as part of White Coat Notes. E-mail Jennifer at jen.shortwhitecoat@gmail.com.

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The intensive care unit is the most aptly named wing of any hospital. Everything about the ICU at Childrenís Hospital Boston is intense: the patients are acutely ill and many require the simultaneous monitoring of each breath and heartbeat. Caring for these patients is intellectually and emotionally demanding for the nurses and doctors.

Many of the patients in the ICU are intubated and sedated and therefore unable to speak. As a student, I visit and examine the patients I am following before rounds every morning. This ritual of pre-rounding is usually my favorite part of the day -ó a chance to chat with the patients in order get to know them better, and also an opportunity to practice my physical exam skills.

Pre-rounding in the ICU, however, is different. One of the patients I am following is recovering from a neurologic injury so severe that she is unable to talk to me or even to open her eyes by herself. In the absence of speech, the many monitors chirp her progress. While in many instances the physical exam during pre-rounding feels perfunctory, in the ICU the physical exam is one of the few windows into a patientís overall condition. I shine a light into my patientís eyes and watch her pupils constrict, a reflex that reveals that the nerves that sense light and cause the pupil to get smaller are intact along their entire tract in the brain. Wielding only a red rubber hammer, I document the reflexes in her arms and legs. I am meticulous, because the smallest change in her physical exam could be the symptom of a larger change in her brain or other vital organ.

In the ICU, lifesaving drugs and advanced technology help keep my patient alive, but as one of her caregivers, all I can do is monitor her progress and wait and hope for her to get better. More than the machines or the array of illnesses, I think it is the collective waiting and hoping of parents and nurses and doctors that makes the intensive care unit so intense.

Posted by Jennifer Srygley at 10:54 AM

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Thursday, July 5, 2007

Short White Coat: Lessons from a little one

Short White Coat is a blog written by fourth-year Harvard medical student Jennifer Srygley. Her posts appear here as part of White Coat Notes. E-mail Jennifer at jen.shortwhitecoat@gmail.com.

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When is a wave not a wave? One of the first patients I saw on the pediatric neurology service at Children's Hospital Boston was a 12-month-old baby who had recently started raising her right arm when she became agitated. Her arm seemed to take on a life of its own, so sudden and repetitive were its movements.

While she had been developing normally -- she could pull herself up and was already saying a few words -- there was concern that her arm-raising might be the sign of something more sinister: partial seizures. When we examined her, she seemed perfectly normal. But a baby's brain can be hard to examine. A more conclusive test would be to monitor the electrical activity of her brain while she was waving her arm.

While the baby didn't seem to enjoy the sticky electrodes placed on her scalp, the electroencephalogram was much more physically taxing on the parents. They stayed up all night to monitor when she was having episodes of arm raising, so that the brain-wave recording could be correlated with the episodes. Even if her parents didn't have to remain wakeful and vigilant all night, I doubt they would have been able to sleep. The hours waiting for a test result to come back can stretch as long as the corridors of the hospital.

For my patient, the results were good. This baby did not have seizures -- just a quirky arm-raising habit when she got upset, perhaps the earliest signs of her personality emerging.

Though her neurologic work-up wasn't complicated, my experience with this patient and her parents reminded me that too often on the wards, we forget that every patient fits into a network of family and friends who worry and wait for every test result.

Posted by Jennifer Srygley at 05:20 PM

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Tuesday, June 19, 2007

Short White Coat: Behind the blue curtain

Short White Coat is a blog written by third-year Harvard medical student Jennifer Srygley. Her posts appear here as part of White Coat Notes. E-mail Jennifer at jen.shortwhitecoat@gmail.com.

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As a student in the operating room, there is ample opportunity to look around. And there is a lot to see: Inside each and every patient is a uniquely beautiful anatomy that tells stories of previous operations or illness; there is the long table with rows and rows of shiny instruments (often named after famous surgeons); there are the clear blue lines of demarcation between sterile and contaminated.

What you donít see very much is the patient's exterior. Except for exposed skin where the incision will be made, most of the patient is covered up. A big blue drape creates a curtain that hides the patientís head and the team of anesthesiologists who quietly toil to keep the patient comfortable and asleep.

Last week, I had a chance to venture behind the blue curtain as part of a one-week anesthesiology rotation. While surgeons cut a swath through disease, it is the anesthesiologistís job to make sure the patient stays alive during the operation. The airway, the heart, the lungs, the eyes, and the skin are all carefully monitored for signs of discomfort or distress. Not unlike air traffic controllers, an anesthesiologist avidly and continuously surveys the patient for the first sign of something abnormal. There is a true art to staring at the EKG stream of a thousand normal heartbeats and then noticing the slight variation that portends of arrhythmia.

In the midst of watching all the monitors, on the anesthesia side of the curtain, I could also look upon the sleeping face of the patient I was helping. For some reason the patientís face, more than the knee or liver or aorta that I could see and touch on the surgical side of the curtain, reminded me of why we were in the operating room in the first place.

Posted by Jennifer Srygley at 06:58 PM

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Thursday, June 14, 2007

Short White Coat: Take a number

Short White Coat, our blog about medical school, has a new blogger: Jennifer Srygley, a third-year student at Harvard Medical School. Jennifer grew up in Tallahassee, FL, and attended the University of Georgia, where she majored in genetics and creative writing. As a medical student, she tries to remain aware of the strangeness and beauty of her surroundings on the hospital wards, all while taking good care of patients. Her posts will appear here as part of White Coat Notes. E-mail Jennifer at jen.shortwhitecoat@gmail.com.

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My day starts and ends with numbers. As a medical student on the surgical service, my first task every morning is to go to every patientís room and record temperature, heart rate, blood pressure, fluid intake, and urine output.

With time, the numbers themselves have come to take on meaning. The number 102, for example, is alternately alarming or reassuring, depending on whether it is a temperature or a systolic blood pressure measurement. There are some patients that I have come to know not only by chief complaint or social history, but by their numbers: Mr. Lís heart usually beats between 70 and 80 times per minute. Knowing this detail is enough to recognize the earliest signs of dehydration when his heart rate climbs to the 90s.

And there is something else. I find it comforting to know exactly how fast the hearts of all my patients are beating. While my task of writing down the vital signs every morning and afternoon does not require any particular skill or training, I enjoy the sense of vigilance and duty that it provides.

The next step in medical training is to know what to do about each number, when to become concerned about the deviation of a particular number from normal, and when to act. The clinical skill of number interpretation will come with time, I hope. For now I am content to carry my patientís pulses on an index card in my pocket.

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Wednesday, June 13, 2007

Short White Coat: Signing out for the summer

Short White Coat is a blog written by first-year Harvard medical student Ishani Ganguli. During Ishani's absence this summer, third-year Harvard med student Jennifer Srygley will take on the blogging duties. Her posts will appear here, as part of White Coat Notes.

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First year ended on Friday with a final exam and a frenzy of packing and goodbyes. Though Iím still feeling my way through the medical system, this year has provided me a unique perspective on health and healthcare issues that affect us all and has led me to think deeply about disparities in the system, the patient-doctor relationship, and the science underlying both. Not to mention that I finally buckled down and figured out my own health insurance plan.

As my classmates dispersed to Boston labs to pipette their way to biomedical miracles, and to other continents to save the world one health survey at a time, I flew into Washington, DC, later that Friday with a slightly different plan: to write about such activities, making both medical research and global health news accessible to the public.

Iíll be spending my one summer break at Reuters, through the Kaiser Family Foundationís Media Internship in Health Reporting. Though Memorial Day has passed, my white coat may get some strange looks at the DC Bureauís health desk, so Iíll have to stash it for the summer. But I look forward to returning to Short White Coat in late August when I start my second year.

Posted by Ishani Ganguli at 11:35 AM

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Thursday, May 24, 2007

Short White Coat: I'm concerned about you

Short White Coat is a blog written by first-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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In Patient Doctor I -- the art of taking a medical history -- several classmates and I intrude weekly into the lives of Beth Israel Deaconess Medical Center patients to practice our interviewing skills and bedside manner.

Last week, these skills were captured in all their glory on videotape as we interviewed "patients," portrayed by actors, about stomach pain and bisexual curiosity. I bumbled my way through the interview, armed with a yearís worth of reading about how far to sit from a patient, what tone to adopt, how to listen attentively, and when to stay silent -- more the stuff of a Miss Manners column than a class textbook.

Though we often joke about such inorganic means of teaching and implementing kindness -- "That must be tough for you" is one empathic statement that we deliberately overuse to the point of absurdity -óIíve found that learning the vocabulary of human connection can be just as critical as the language of human anatomy and disease.

Take "concern" -- Iím concerned about how your six-pack a day might be affecting your health; do you have any concerns about controlling your asthma?; it sounds like youíre concerned that this might be cancer. Equipped with this word alone, we can convey caring, encourage positive life changes, uncover diagnoses and treatment strategies, and elicit patientsí fears or the real reasons behind their visit.

When I was first robed in a white coat and thrust in front of a patient last fall, I felt uneasy adopting such vocabulary because it implied that I had some clinical expertise to offer. Over dozens of interviews and scores of awkward moments, Iíve come to realize that talking the talk without walking the walk, so to speak, can be valuable in its own right -- as long as you use the right words.

Thinking back on my first year, I wonder whether this language has been the most lasting lesson in some ways, a piece of medical school that has readily seeped into my relationships with friends and family in ways that endear rather than alienate. As our Patient-Doctor preceptors reminded us yesterday in our closing session, even a seasoned doctorís most critical skill is making conversation. Itís not a bad skill for life, either.

Posted by Ishani Ganguli at 03:49 PM

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Tuesday, May 15, 2007

Short White Coat: Society Olympics part 2

Short White Coat is a blog written by first-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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As promised, a follow-up to the Society Olympics preparations I wrote about last week: Cannon didnít quite bring home the pink flamingo on Friday, but we trailed the winning team by a meager four points out of their 88. Despite losing our chance at the plastic bird, and our voices from cheering so loudly, the day was well worth the sleepless nights preceding it.

Pranks came to a head on game day. After the distraction of morning lectures, the five societies braved the rain to enact elaborate processions before a panel of distinguished judges at the tennis court.

Castle Society played off its David Castlehoff theme with impressive Baywatch-style lifeguarding maneuvers in a kiddie pool, while Peabodyís "P. Biddy"-themed procession had hip-hop fans swooning and throwing undergarments upon the hip hop mogulís enacted arrival. Health Sciences and Technology (HST, a society as well as a separate program) presented choreographed vignettes of television shows with chemistry-kit inspired stunts. Holmes Society showed off its school spirit (its theme was Holmescoming) with a one-man marching band and crowned homecoming nobility, while our similar high school theme (Cannon High, to be specific) had us recreating the awkward hilarity of teenage dances.

The pie-eating competition was messy, though regurgitation was kept to a minimum. The same could be said, thankfully, for Dean Joe Martin when he judged the Iron Chef competition. After the dance-off, in which I fulfilled a personal fantasy in my cheerleader skirt and pom-poms, Cannon dominated the dodgeball tournament after a dramatic reversal of a one-on-three match accomplished in large part by staring down the competition.

Throughout the afternoon, alliances were formed and quickly forgotten, and congratulatory pats and celebratory hugs were in ready supply. The relay race had us mimicking a typical day in the life of a doctor: put on scrubs, shave a kiwi, and resuscitate a plastic mannequin. Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine, refereed a contentious tug-of-war championship. After some strategic cheering and a few do-overs, Cannon was declared the winner for the third event in a row.

Giddy from cheering under the by-now hot sun, we retired indoors for catered barbecue and an announcement of the winner -- HST. By late evening, trash talk and our grass-stained T-shirts were thrown aside as we celebrated together as a class. The only competition that night involved plastic Solo cups and ping pong balls.

Posted by Ishani Ganguli at 02:25 PM

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Wednesday, May 9, 2007

Short White Coat: Let the games begin

Short White Coat is a blog written by first-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

Iíve worn the same T-shirt every day this week. Itís not because of my pressing need to do laundry so much as team solidarity ó- this Friday, my medical school society (Cannon) plans to beat out the others in the Society Olympics, and our matching goldenrod shirts are just the start of our efforts.

Harvard Med is divided into societies named after big-time physicians of years past (Dr. Walter Bradford Cannon discovered the "fight or flight" phenomenon). For most of the year, the main differences between them are the quirks of society masters, the amount of toner in the society printer, and whether our food funds are directed towards post-exam ice cream or weekly lunches. On Friday, all five societies will be facing off in a series of epic battles to win bragging rights and, according to rumors, a pink flamingo.

Some of the events are more traditional, ones you could imagine taking place at ancient Greek medical schools: tug of war, limbo, a dance-off, dodgeball, and a low-fat pie-eating contest. In the HMS version of Iron Chef, weíll have to create a going away cake with $8 worth of vending machine snacks for retiring Dean Joe Martin.

Leading up to this Friday, pranks abound. Yesterdayís microbiology quiz was preceded by two Speedo-clad David Hasselhoff impersonators running across the front of the auditorium. Cannon Society planted a few extra multiple-choice questions on the quiz, which Cannonites took while sporting white bandanas "borrowed" from another society's costume scheme. Itís a rare lecture this week that isnít supplemented with a video clip or Powerpoint presentation promoting one of the societies or mocking another. An impediment to learning? Iíd argue itís more like motivation to go to class.

Besides society bonding, and a needed outlet for spring restlessness, there are other benefits coming out of this mammoth endeavor: the good deeds that have been incentivized by the promise of Olympics points. We get them for every sweater we donate or community organization for which we volunteer. With the pass now/pass later grading scheme at HMS, former pre-meds need another way to flex their competitive muscles, and community service is a better choice than most.

Let the games begin! Check in with ShortWhiteCoat for an update on the competition (ie. when Cannon wins).

Posted by Ishani Ganguli at 08:50 PM

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Monday, May 7, 2007

Short White Coat: Bugs on the brain

Short White Coat is a blog written by first-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

Medical school has made a hypochondriac out of me. As weíve been learning to sharpen our diagnostic acuity, Iíve self-diagnosed everything from blisters to brain hemorrhages -- and thankfully, I am almost always wrong. But now that weíre knee deep into microbiology, meeting the cast of minuscule characters that are harmless and insidious in turn, my paranoia may be slightly more justified.

We play with these bugs nearly every day in micro lab, staining them and feeding them in different ways to figure out their identities. The bacteria responsible for meningitis were taken off the roster this year (just in case), but I have to say, Iím not too thrilled about the notion of acquiring a skin-peeling staph infection or gonorrhea either.

My tendency to squirt unidentified liquids into the air during lab does little to ease the mind. And in fact, several classmates have come down with mysterious sore throats and achiness, and bacterial conspiracy theories abound. Stay tuned to Short White Coat for news of a major outbreak....

The good news is that they also teach us how to protect ourselves, in micro lab and elsewhere. Alcohol-based hand cleansers are the way to go, we learned; if youíre using soap and water, you need to scrub your hands for 15 seconds to get the same effect. It doesnít sound like a lot of time, but try counting to 15 the next time youíre at the sink. Itís definitely changed the way I go about my day, especially since the medical school is equipped with Purell dispensers at every turn of a hallway.

Sometimes a lesson learned in kindergarten takes 17 or so years of further education to sink in, I suppose.

Posted by Ishani Ganguli at 11:38 AM

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Monday, April 30, 2007

Short White Coat: Medical School-house Rock

Short White Coat is a blog written by first-year Harvard medical student Ishani Ganguli. Ishani's posts appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

Now that lectures are videotaped, Harvard medical professors seem to be hamming it up for the camera, using song and dance to entice students to watch and learn.

Earlier this month, Shiv Pillai tried genres as diverse as the ode, the mantra, and hip hop to summarize and attach some sort of teleology to complicated immunology pathways while lightening up otherwise tedious lecture-packed days. His melancholy take on T cells: "Looking for antigen below and above, Many will die of unrequited love."

"Thread that peptide into TAP," he added with an enthusiastic shimmy, encouraging us to join in. "Everybody do the lymphocyte rap!"

Unshockingly, the approach isnít limited to graduate education. Some of my friends from college are turning hip hop into an educational tool for middle schoolers, mixing catchy beats on topics including the circulatory system and fractions. In a family opera production at the Cambridge Science Festival last week, evolution was festively summed up in a 23-part oratorio.

Singing and rapping educators are on to something. Analogy and anthropomorphosis are potent means of understanding concepts (for example, I like to think of the way your immune system learns what to attack as a slightly morbid version of speed-dating for white blood cells). If thereís a tune or a beat attached, one that you can hum under your breath or tap on your desk while taking an exam, even better (never mind the annoyance of neighboring students).

We learned last Thursday that the music need only be inferred to be an effective learning tool: In a microbiology lecture on sexually transmitted infections already enhanced by stick figure drawings, Michael Starnbach used the immortal lyrics of Frank Zappa to illustrate the clinical manifestations and social implications of gonorrheal infection.

"Why does it hurt when I pee?," Zappa heart-wrenchingly inquires. In Starnbachís impressively straight-faced dramatic reading, complemented with medical references, he answered this question (for one thing, Zappa was wrong to blame the toilet seat) and so much more.

Posted by Ishani Ganguli at 04:10 PM

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Friday, April 20, 2007

Short White Coat: What students can do

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. Ishani's posts will appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

By now the statistics, and the photos that bring them to life, are familiar but no less jarring: Ten million people die each year from preventable and treatable causes -ó mostly infectious diseases long forgotten in the developed world. Developing nations account for 90 percent of global deaths but only 10 percent of pharmaceutical sales each year, in large part because drugs arenít affordable.

Our spring course on Social Medicine switched this year from elective to mandatory as testament to a growing emphasis on humanism in medicine. Headed up by such global health celebrities as Jim Kim and Paul Farmer, the class tends to be focused accordingly, on problems in the developing world.

On Thursday afternoons, Farmer or Kim, co-founders of Partners in Health, stand behind the podium, present such statistics, and ask us what we can do to solve these problems in an earnest tone that suggests that even they, despite their decades of dedication to the cause, have little idea.

Sitting in the lecture hall, itís easy to feel overwhelmed and inadequate in the face of such challenges. But as our professors -- who began their global health work when they were classmates at Harvard Medical School -- know, students have a unique drive and capacity to effect change, especially on their home turf.

Two of my first-year friends, Craig Szela and Cyrus Yamin, are doing just that, calling universities to task on their global responsibilities. Theyíve joined a national student movement, Universities Allied for Essential Medicines (UAEM), to convince Harvard and other institutions to help increase access to lifesaving drugs.

The idea is this: basic research in federally-funded university labs feeds a significant proportion of pharmaceutical pipelines for drugs against diseases like HIV/AIDS and tuberculosis. Get universities to stipulate in licensing agreements that essential medicines developed from their research be produced cheaply (read: generically) for the worldís poor to afford, and millions of lives will be saved. Backed by Farmer, Kim, four Nobel laureates, and a number of other prominent figures, UAEM is making clear progress.

Waxing eloquent on multi-drug resistant tuberculosis and intellectual property, Kim spoke before a packed lecture hall in Harvard Yard this week to mark UAEMís National Day of Action (April 18), recognized across nearly 45 universities. At the end of yesterday's Social Medicine lecture on the same topic, Kim, a former head of global AIDS programs for the World Health Organization, reminded us of the credo behind the course -- "to teach [us] how to think socially about terrible problems like drug resistant TB and HIV, but then to understand how you can make a difference."

"Craig and Cyrus are making a difference," he declared. Empowering words for two first-years to hear, coming from the likes of Kim.

Posted by Ishani Ganguli at 07:05 PM

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Monday, April 16, 2007

Short White Coat: What I didn't learn in high school biology

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. Ishani's posts will appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

Who says medical school canít be fun? Iím taking Human Sexuality in Medicine, a spring elective meant to supply future doctors with the knowledge and vocabulary to discuss this sometimes uncomfortable subject with patients. In previous weeks weíve covered the anatomy and physiology of it, as well as what can go wrong.

During Thursdayís session, a sex therapist with effusive gesturing habits shared her experiences in the field with our predominantly female classroom.

Lessons learned: Talk to each member of a couple individually to root out the cause of complaints in the bedroom. Donít be afraid to talk methods. And even 85-year-olds have concerns about sex (so ask).

Besides discussing how to bring up sexuality in a patient doctor conversation (Do you have sex with males, females, or both? is the somewhat jarring standard), we addressed such questions asówhat happens when a patient hits on you? And what if you accidentally hit on him? It was the type of conversation Iíd have with girlfriends, poring over Cosmo at a sleepover (yes, such stereotypes are valid). But this time, we were taking it to a professional level, with the guidance of an expert.

Class was followed with a highly anticipated field trip to the Brookline branch of Good Vibrations, a chic ďsexuality product retailerĒ with a sense of humor. Store-clerks gave us a hands-on tour of the boutique, pointing out books, videos, toys, games, and other merchandise designed to shield, stimulate, and educate. On several occasions, I was compelled to check if my phone was vibrating (it wasnít).

All in all, we picked up information thatís good to know, for our future patients.

Posted by Ishani Ganguli at 01:33 PM

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Wednesday, April 11, 2007

Short White Coat

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. Ishani's posts will appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

The air around the medical school quad was rife with the promise of autumn and movie stars last week.

Brightly colored leaves were plasticótaped to the branches of budding trees lining the quad and strewn on the surrounding grass last Tuesday for the filming of a scene in Columbia Pictures' "21." But besides Jim Sturgess, the star, the other actors in the movie (including Kevin Spacey, Laurence Fishburne, and Kate Bosworth) were nowhere to be stalked.

"21" is directed by Legally Blondeís Robert Luketic and based on the best-selling book "Bringing Down the House: The Inside Story of Six MIT Students Who Took Vegas for Millions." It turns out one of the six gets into Harvard Med at the end of the movie, so the film crew arrived here before dawn to recreate an autumn scene.

Fake medical students were planted all around the quad lawn, standing beside their bicycles or chatting in clusters. Larger crowds of these movie extras followed around a beckoning crew member, back and forth ad infinitum, as the real students looked on.

The most striking feature of our movie selves was the nearly uniform attire: long woolen coats and sharply pressed khakis, offset by overstuffed backpacks. The professors were mainly of the elderly, bearded or mustachioed variety, not quite as diverse as we usually see on campus.

Not a bad impression overall, though many of us not-so-secretly wished we could have played ourselves. Iím excited to see the finished product and to find out just how close they come to capturing something of the medical school setting.

Not that it matters necessarily in Hollywood.

Posted by Ishani Ganguli at 05:27 PM

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Tuesday, April 10, 2007

Short White Coat

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. Ishani's posts will appear here, as part of White Coat Notes.

Call it a testament to the mediaís role in education, or total cluelessness on my part: I discovered today, when reading Liz Kowalczykís piece in the Globe on the white coat hierarchy and in a subsequent conversation with a fourth-year friend, that my classmates and I may be wearing the hip-length version of the white coat through our residency training and even as attending (senior) physicians. So much for the distinguishing mark of a medical student.

I will argue, however, that the true mark of a medical student can still be considered the wearing of said coat outside the hospital. Residents and even higher-up med students usually know better. While first-years are still enamored by the short-white look, my guess is that one wants to shed the garment as soon as possible after wearing it for twenty-four hours straight.

I got a welcoming e-mail today from Paul Levy, president and CEO of Beth Israel Deaconess Medical Center and, dare I say, a fellow blogger. After the initial shock that someone besides my mother -- and a health care honcho at that -- read my first entry, I was pleased to see todayís great equalizer, the blogosphere, at work.

Iíd read about the "blogging community" before, but as a newly inducted member, Iím looking forward to more such interactions as well as conversations with readers. Please feel free to e-mail me at shortwhitecoat@gmail.com with ideas, concerns, or general musings on medical education.

Posted by Ishani Ganguli at 06:52 PM

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Short White Coat

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. A short white coat is the hip-length garment worn by medical students to signify their place in the medical hierarchy. Ishani's posts will appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

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Under the mandate of Harvard Medical School's recently unveiled New Integrated Curriculum, my professors draw connections with fresh gusto, whether it is between disciplines or from benches to bedsides.

For one such integrated experience during my physiology course, I accompanied classmates to the intensive care unit at Beth Israel Deaconess Medical Center one day last month. Eight of us gathered in a meeting room outside the unit so that our professor could tell us about the patient we would observe and discuss, in an attempt to heighten our textbook appreciation of the lungs and kidneys.

As he finished describing a 45-year-old woman's unrelenting multi-organ failure and led us into her room, I mentally prepared myself for the sight. It wasn't my first time in the ICU -- I had been exposed as a candy-striper in high school -ó but it was the first time I could bring any real medical knowledge to bear in such a setting, and it was a daunting prospect.

The patient's face was pea green from liver failure; a labeled rectangle of scotch tape was affixed to her left cheek as if it were an inanimate object. I stared dumbly at her lying there, machines taking over for virtually every function of her organs. She seemed a bridge between the cadaver that first appalled, then hardly fazed me in anatomy class last fall, and the patient whose medical story I had solicited in a practice interview the week before.

Pausing little for reflection himself, my professor began to quiz the group on her heart function and prompted me and my classmates to do quick mental calculations of her breathing volumes. In these moments of first-year naivete, it was a glimpse into my third and fourth years in the clinics, and the ritual of being "pimped" by medical superiors -ó that is, questioned on medical knowledge in front of patients and hospital staff. Wondering whether she could hear me in her comatose state, I swallowed my sense of futility and started to do the math.

I was connecting my textbook learning with the patient case in front of me, certainly. But I was also helpless to do anything with that connection to actually help her, and my presence in that room -ó my integrated learning experience ó- seemed an impediment to any hope she had to survive. Despite my rational understanding that I was being trained to treat future patients like her, I felt uneasy to be using her for pedagogic ends, and dreaded the thought of her loved ones walking into the room.

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