Today’s Date: Aug. 24, 2011
Total Hours to Date: 30 hours
Mentorship Research Journal #2
My visits to the VCU Main Hospital have recently become nearly full-day expeditions. This second journal entry will document the past two long but busy days spent with Dr. Gravatt. My Aug. 23 visit to the hospital began with rounds, once again with the team. That morning, we saw a total of 10 patients.
Due to the fact that internal medicine deals with all types of diseases, the patients we saw were admitted for a wide variety of reasons, from heart failure to chronic kidney disease to hallucinations. Thus, we were always on our feet, quickly moving from one hospital floor to another. We only stopped to listen to the reports from the medical residents, who had come to the hospital very early in the morning in order to check on their designated patients and prepare a health report. This typically required an overview of the patient’s various lab test results and recent symptoms, as well as a recommendation from the student regarding further action. The team’s physicians would follow along, ask questions, and make amendments as needed. Listening to each report, I was able to better understand the obligations that came with fulfilling a residency requirement.
One patient of interest was a 31-year-old female who came into the hospital, like many other patients, with a history of drug abuse. She had developed a fungal infection around her calves, so her doctors had prescribed antibiotics to treat it. However, instead of taking the antibiotics as instructed, she injected heroin into her legs to ease the pain. This case exemplified one of a doctor’s many frustrations: a patient’s refusal to follow his or her directions. Thus, it is crucial that the doctor develop a good bed-side relationship with the patient. If the patient feels she can trust her doctor, she will be more willing to do as he asks.
Another recently admitted patient was a 60-year-old man. His wife explained that he seemed to be suffering from acute depression and anxiety following his cancer diagnosis. He had an extensive medical history, and some members of the team questioned the necessity of taking so many drugs. Dr. Gravatt took notice of his use of the beta blocker propranolol, which serves to control anxiety, and wondered if it fed into the patient’s depression due to its passing of the brain blood barrier. She recommended that they take him off several drugs to see if his condition would improve. This was a case in which a pharmacist could not only recommend prescribing certain medications, but take them away as well. In this situation, less medication would have been more beneficial, and the importance of knowing one’s medical history became evident.
My afternoon consisted of attending lectures presented by both professors and students. The first class took place in one of the main classrooms of the School of Pharmacy. The lesson focused on different types of Gram positive bacterium. Coincidentally, this topic correlated with what I had recently come across while on rounds, as mentioned in the first journal entry. Dr. Gravatt had informed me beforehand of the two main types of Gram positive bacterium — staph and strep. Hence, the teacher began the lesson by presenting an NPR recording about MRSA, a bacterial infection that is particularly resistant to antibiotics. The recording stated that by simply increasing the frequency of handwashing among the staff members, the number of MRSA cases declined. She then proceeded to cover many types of staph and strep infections, such as streptococcus pyogenes, a tissue infection caused by a virus. She explained that penicillin is the main treatment of choice for this for this disease, unless the patient is found to be allergic to it.
The next set of lectures was presented by pharmacy students, who were expected to explain to the audience what they had learned through their experience with an assigned patient case. Each presentation discussed the reasons the patient was admitted, assessment and lab results, treatment, and details on how the patient responded to said treatment. These students’ presentations were then analyzed by a panel of physicians and pharmacists. For example, one student described a pharmacist’s role in treating a woman’s endocarditis, a heart inflammation, by prescribing Vancomycin, an antibiotic used to treat such inflammations.
I finished that long day realizing that the residency programs truly prepare students for their careers, for their work in such programs closely resembles what they will probably face in the future. Yet, I was certain there was much more to learn, both in the classroom and out in the field.
On Aug. 24, my day began at 8 a.m., reporting straight to class. That day, Dr. Gravatt gave a lecture on the basics of infectious diseases. She began by reviewing the concept of the normal flora, a name for the numerous microorganisms that regularly colonize the human body. When normal flora is disturbed by immune system dysfunction, skin breakdown, etc., the bacterium can become pathogenic, which leads to infections. She discussed how the immune system functions and possible causes for immune dysfunction.
Dr. Gravatt explained most of the lesson with theoretical patient cases; she would present a theoretical patient, then describe the step-by-step process students should follow. She brought up details to be wary of, like the fact that it was possible to have an infection without having a fever. Overall, I found the class much more direct than my high school classes, simply because the School of Pharmacy’s teaching methods and materials are directly related to the challenges students would face in a hospital or clinical setting.
The later part of the day was spent focusing my attention toward the students. The resident pharmacy students had been assigned patients who had actually been recently admitted into the hospital. The students were responsible for researching these patients’ medical backgrounds and presenting them to Dr. Gravatt as patient cases. This way, Dr. Gravatt was able to quickly gain information on her patients while teaching her students. In one of these cases, a woman had been admitted to the hospital after experiencing a 20-pound weight gain. More importantly, she suffered from heart failure in her right ventricle. As a result, the left side of her heart had been working twice as hard, leaving this side much stronger than its counterpart. This unbalance in the organ led to more issues, such as constriction of blood vessels. A metal rod had been inserted into her chest to compensate for the right heart failure, and so it was imperative that her pharmacist prescribe an anticoagulant drug, or a blood thinner, to protect the patient against possible blood clotting.
All in all, during these past two days, I’ve had the fortune of observing an actual pharmacy class as well as learning exactly what completing a residency entails. Although I sometimes felt overwhelmed by the medical terms, I found the use of patient cases an interesting method of teaching. As Dr. Gravatt explained, treating a patient is much like solving a puzzle — you often aren’t entirely sure from what disease the patient suffers, so you must put the symptoms together to try and solve the problem from these clues.