February 2018

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Medicine: A Work of Heart
By Deepam Joseph, M3

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We sit in the physician’s workspace, staring as the scan lights up in sparkles of yellow and orange, outlining the malignancy lining both lungs. It is the news we dread to deliver. We make our way over to the patient’s room; this white coat seems heavier over my shoulders today. We knock on the door, enter the room, smiling while greeting Mr. A and his wife. Mr. A is on the bed, resting. His wife sits on a couch diagonally from the bed. The attending tackles the conundrum of positioning himself in the best way possible to face both of them simultaneously, ending up in a pretty uncomfortable position seated on the frame of the bed. He decides it’s better to sit comfortably facing the patient instead. The attending begins by giving a summary of problems that have afflicted Mr. A thus far. His speech, deliberate at first, slowly gathers momentum, trying to piece together the puzzle to explain the final gruesome diagnosis. Then, the news is out—pin-drop silence follows. A minute passes, then another minute ...

“So Doc, are you saying that I won’t be alive in 10 years?” I gulp hard to get rid of the expanding knot in my throat—our words did not paint a clear enough picture of how poor his prognosis was. Or maybe they did, but Mr. A chose to hold on to hope a little longer. The attending explains that his life expectancy was on the order of weeks to months, instead of years. “Okay,” Mr. A replies. A minute passes, or two, it seems … and then he breaks. Tears streaming down his face, he sobs uncontrollably and exclaims, “So Doc, you’re saying I will not be able to drive my blue truck for much longer?” We know about the healing power of touch, so we lay our arms around him and his wife. We offer an endless amount of tissues, we purposefully linger.

We leave the room, close the doors, and compose ourselves. My attending remarks that he has delivered this news several times, but he has never heard that response before. We move on and enter the next patient’s room. This patient does not have cancer. This patient wants to be discharged and is angry he had to wait so long to be seen. We apologize and calmly assure him that we will address all of his concerns and discharge him before the end of the day so he can be with his family once again. As professionals, this is what we do. We put on a multitude of masks and shove our emotions to the furthest parts of our mind until we have time to face them.

I come home and hang my coat on the door. I set the coffeepot to boil. I finally sit down to study, my notes splayed over the entire table, coffee resting at my fingertips. I stare at the notes before my eyes, but my mind wanders off to rest in Mr. A’s room. Then it dawns on me—Mr. A was not grieving about not being able to drive his blue truck in the simplicity of the literal sense. He was mourning not being able to go places in his blue truck and marvel at the beautiful creation that God put in place around us. He was mourning not being able to make memories with the people that he loves. He was mourning the life that was being snatched away from him before his time.  

Sometimes I wonder if these stories are mine to tell. They exist, whether I listen, whether I pen them, whether I expose my heart to feel them. This—all of this—is a privilege. Sometimes I wonder if it is an invasion. But I let them occupy a place in my soul, teaching me how to serve in medicine. I let them be.


Interview with Paul E. Ogden, MD
By Radhika Shah and Sarah Joseph, M1s

  Paul Ogden, MD, former vice dean for academic affairs  .

Paul Ogden, MD, former vice dean for academic affairs.

Dr. Paul Ogden most recently served as the vice dean for academic affairs and vice dean for the Bryan-College Station campus at TAMHSC. In his time at TAMHSC, he also served as the interim dean of the College of Medicine from 2013 to 2017. In addition, he was a member of the charter class of TAMCOM, the Class of 1981. He is now the provost at the TTUHSC Paul L. Foster School of Medicine in El Paso. We interviewed Dr. Ogden shortly before his departure. Highlights follow.

Radhika: How long have you been with TAMHSC?

Dr. Ogden: Thirty-two years in total. I started here as a medical student beginning in 1977. From there, I trained in family medicine in Waco and finished my internal medicine residency at the Mayo Clinic. I later returned to TAMHSC to practice and teach.

Sarah: How has the TAMHSC community impacted your life and/or career?

Dr. Ogden: In so many ways. I am grateful to have found the “perfect” job.  I love practicing medicine and I love teaching medical students even more. During my time at TAMCOM, I was able to do both. My favorite thing about my career is definitely teaching medical students at morning rounds. It’s fun, haha—having all those students trailing behind.

Radhika: From your time as a medical student in the charter class at TAMCOM to now, what do you think makes being an Aggie doc so special?

Dr. Ogden: This school truly cares about leadership and service. The people they’ve selected to be leaders are really a good group of people. They encourage medical students to be leaders too. They encourage students to go out into the community and practice their skills. Aggie doctors are people that you can trust; they want the best for you.

Radhika: If you could share some wisdom with our future Aggie docs, what would it be?

Dr. Ogden: I would say that you need to find whatever you’re passionate about and do that to the best of your ability. My career never seemed like a chore. I was lucky enough to find my niche. Secondly, to medical students—when choosing residency programs, make sure you keep passion at the forefront of your mind. The training is what matters, not necessarily the city you might want to live in.

Sarah: What is your favorite memory here?

Dr. Ogden: The day we went to see Katrina evacuees. In 2004 and 2005, I started doing simulations, and we were doing simulation trainings, basically learning how to do procedures. Katrina happened in late August of 2005. When something like that happens, you never forget it.  All those people, all the evacuees were dispersed—and many came to Houston and other parts of Texas. A good number actually ended up in Fort Hood. The clinic was overwhelmed. So many of the evacuees had serious health problems and really needed assistance right away. There was a lady who said that she was on the roof of her home because of how much it had flooded. While trying to get on a helicopter, she cut her leg open. There was also an AIDS patient who hadn’t been able to take his medications because the flood had washed them away. There were some serious patients that needed some serious help.

I remember I was teaching 8 med students at the time. I asked, “Do y’all wanna do this?”

They said, “Yeah! Let’s go!”—so we went. That was the beginning of students helping at the free clinic. It was an extremely rewarding experience because in some way, however small, we were able to help each person who came into the clinic. The students also got to witness things they had never been exposed to before. It’s amazing. Students now run that free clinic in Temple, all because of that one day.

Sarah: If you could describe medicine in one word, which word would you choose and why?

Dr. Ogden: Vocation. In my mind, medicine is something you are called to do, and you must be willing and ready to accept that call. There is some discernment involved because it is not always going to be what is convenient and easy. So you can’t always expect things to run smoothly. But, if you treat it as a vocation rather than a “job,” it will always be meaningful, wonderful, and rewarding.

Radhika: Over the years, what do you feel is the most important thing your patients have taught you?

Dr. Ogden: Firstly, to be a better listener. I remember always being the student or resident interested in getting the right answer, and I didn’t always listen—I mean really listen—to the patient. But patients can tell you so much about themselves, their lives, and their backgrounds—but you have to be able to listen, read between the lines, and pick up on nonverbal communication. Really the nonverbal communication can sometimes be the most important.

Radhika: What is the one thing you will miss most about being with TAMHSC?

Dr. Ogden: Probably the people I worked with. They were and are good people who push each other to be better. And, regardless of opinions/politics, everyone cared about the medical students, everyone shared the same goal.

Sarah: This career can be stressful at times. What are your tips and recommendations on dealing with and relieving stress?

Dr. Ogden: As a student, make sure to keep some balance in your life. Set aside times to do other things—things other than studying for medical school.  Basically, make sure you have a few hobbies and things you look forward to doing each week. I would also advise students to plan out their days. For me, there was always a time to study, a time to eat, a time to exercise, and a time to socialize. I made sure to do all those things to the best of my ability. I tried my best to make sure nothing fell short. It really helped me stay happy and healthy throughout medical school and even after.

Sarah and Radhika: Time for some fun questions! Favorite place to eat in BCS?

Dr. Ogden: Chuy’s.

Sarah and Radhika: Favorite book (most impactful)?      

Dr. Ogden: Pillars of the Earth (England 1040, monastery that wants to build a cathedral) and Michener's Texas (historical fiction).

Sarah and Radhika: Favorite artist/band?

Dr. Ogden: The Beatles.

Sarah and Radhika: Hobbies?

Dr. Ogden: Golf and mowing the lawn. I was like a “grass man”—I had a lawn and gardening business.

Sarah and Radhika: Pets?

Dr. Ogden: Dog – Miniature Schnauzer (Allie).


Escalating Tones
By Carolina Orsi, M1

  Carolina Orsi, M1, uses her art to relax and prevent stress. Photo by Alejandro Orsi.

Carolina Orsi, M1, uses her art to relax and prevent stress. Photo by Alejandro Orsi.


Not Your Average Doctor
By Kaykay James, M2

July 2016: White Coat Ceremony

“Hey man, that’s my spot.” I turned around to see a skinny Indian student pointing at where I was sitting.

“Sorry man,” I muttered as I shifted one seat to the left. He sat down but seemed restless. Here we go again, I thought. I smiled, extended my hand, and introduced myself, hoping to calm his nerves. I looked around to assess the number of black students in my class: 4 out of 192 total students.

Three months later, he jokingly tells me that he was intimidated when he first met me and thought I was in the wrong room when my peers were receiving their white coats. I laughed hard for a good five seconds and then locked eyes with him. “Because I am black?” His facial expression shifted immediately from genuine laughter to apprehension. “I’m joking, man. Just messing with you,” I swiftly reassured him. There is some truth in every joke.

September 2016: Texas A&M Rec Center basketball court

“Damn bro, you’re huge. Do you go to this school?” Bewildered, I paused and looked at the young, white, red-headed male student. I wondered if he asks everyone this question.

“Yeah man, I do.”

“What year are you?”

“Oh, I’m in grad school.”

“That’s cool, that’s cool. What are you studying?” I paused and contemplated whether I should just leave it at grad school or answer the question. I hate this part of small talk. I know exactly what’s coming next. Nevertheless, I decide to entertain him.

“Medicine.”

“Oh wow, really? How?”  

I smiled and laughed. Is it really that strange? Big. Black. Male. Medical student. Maybe it’s just this town. This was the fifth time in three months.

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December 2016: Conversation with roommate’s mother

“So, you’re in medical school? Wow, that sounds intense!” the woman exclaimed. Chris’ mother is a sweet middle-aged white woman with a generous heart. At this point, I have already fast-forwarded this conversation in my head based on my previous experiences. I am five steps ahead of her. This time will be different, I thought.

I continued mixing my oatmeal—2 cups of milk, 1 cup of oats. As I stirred my breakfast, I hoped that she wouldn’t be like the others.

“So, you mean … you’re in PT school.” I smiled and laughed.

“No, ma’am. Medical school.”

“So, you’re going to be … like … a real doctor … an M.D.? You sure it’s not like PT school?” Really? Is it that hard to fathom?

“I would hope so,” I chuckled. “If not, I am just wasting my time and money.”

“You just don’t look like it.”

There it is. Like clockwork. Maybe it’s just Texas.

October 2016: White Coat Experience

“Hello. My name is Kaykay James and I am a first-year medical student with the Texas A&M College of Medicine. I appreciate you taking the time out of your day to help me gain experience in interviewing a patient.” She forced a weak smile and welcomed me inside.

As I proceeded to interview my patient about her medical history, I sensed an initial hesitation and uneasiness as she fiddled with anything she could get her hands on. I assumed my presence disturbed her because I was a black, muscular male speaking to a Caucasian woman. Not again, I’m not going to bite you.

This preconception that older white women are uncomfortable with young black men quickly vanished when I leaned backward and spoke with a softer voice. I realized her distress was a direct result of my voice volume. Although I wanted to display confidence, this was hindering her willingness to respond. As a result, I dialed down my volume to match that of my patient. She immediately relaxed and began to smile more. The rest of the interview went smoothly as I empathized with her current predicament. Hearing her life story and the struggles she’s overcome humbled me and reminded me how blessed I was to be healthy.

I walked out of the room with a smile plastered on my face. Maybe it is all in my head.


Reflections: Anatomy Lab
By Mouctika Paluri, M1

12/1/2017

Today was our last day of anatomy lab, and it feels somewhat like the end of an era. We have another week of reviews and one last anatomy practical to take, then most of us will never set foot in lab again. Although it seems silly that a 4-month lab course at the beginning of medical school could potentially change a person fundamentally, I truly believe that I have been changed for the better (and possibly for the worse) by this experience.

I have always been fascinated by the human body. Even as a third grader, I remember flipping through pages of an anatomy book we had at home—I could not believe all the colorful structures and vessels I saw could actually be inside my own body. Whatever your beliefs are regarding the creation of the human body, there’s no denying the end result is a masterpiece in every sense. Even with the infinite list of things that can go wrong over the course of our lives, I’m amazed by everything that goes right and keeps us going every day.

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Without a doubt, participating in lab gave me immense respect for the minute details behind every movement and breath we take. Every time we step back and observe how every organ, vessel, and nerve seamlessly performs its job and blends into an orchestra underneath our bones, I’m at a loss for words. My 8-year-old self could not have imagined what a true privilege it is to know the human body on such a deeply personal and tactile level. However, the road to achieve this understanding has not always been smooth. In addition to the effort required to get into medical school and have access to this experience, the actual process of attending and conducting anatomy dissections has exhausted me both physically and emotionally.

Going into anatomy lab the second week of school, my overwhelming emotion was fear. I had been lucky enough to have never seen a dead body in person before, but now I was about to be surrounded by 30 of them and would actually have to cut into one. Before this semester began, I never really had to identify or challenge my beliefs regarding death and its aftermath. Growing up in a Hindu household, I was briefly taught that bodies are commonly cremated and the ashes kept away or dispersed very soon after death because burial is not our standard practice. In all honesty, death was always a taboo topic that was mentioned as little as possible. Because of this, the idea of spending months around a perfectly preserved cadaver seemed foreign and daunting to me—I even remember my mother being horrified when I told her about this detail. Even now when I walk into lab, I have an initial moment of shock and sadness when we uncover the cadaver. I often feel compelled to pray to myself before a particularly involved lab to “make peace” with what I am about to do to another person. I reassure myself that we are performing these tasks for the purpose of learning and that most of the cadavers were willing and selfless donors—our “first patients” as our professor called them. I have always placed the respect and dignity of the cadavers above everything else in lab. However, when I look back on the experience, I see that I have still become hardened in ways I never expected.

Over the course of the semester, we repeatedly have to depersonalize and compress a potentially all-consuming experience into regimented 3-hour labs with our classmates. As we progressed through the course, it seemed like all my classmates were able to “get over” the surreal nature of our tasks and compartmentalize their perceptions much better than I was able to. For me, dissection felt like a very intimate process because we literally remove a person’s skin and bones to observe the endless structures lying inside. During lab, I saw this profound interaction transform into a common “social setting” where tankmates were often found discussing weekend plans, music, relationships, gossip, and even restaurant preferences with each other.

These lighthearted conversations seemed like a defense mechanism to distract our minds from focusing on the magnitude of what our hands were doing. If we allowed ourselves to feel the gravity of dissecting a human being every single time we went into lab, we would all probably burn out. I myself have noticed that on the days I threw myself into dissections without enjoying the company of my tankmates, I felt more drained than ever.

To me, this coping process seems like a microcosm of medicine as a whole. As we enter clinical experiences and witness more and more violence, abuse, neglect, and death, we will be required to dissociate ourselves just enough to ensure we provide the best care to each of our patients. Spending time in lab has given me the opportunity to build these skills in a low-stakes setting so that when a patient’s well-being depends on my ability to compartmentalize my emotions, I will already know how to do so.

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Some days, the cruelty and coarseness of the dissection process seem to outweigh the learning benefits of lab. Our anatomy tanks switch cadavers every unit to gain experience dissecting different body types and genders. During our abdominal/GI unit, we were assigned a cadaver who had suffered from pancreatic cancer. This meant our dissections for this unit were fruitless and, at times, nearly impossible to perform. Our time in lab was largely wasted as our attempts to learn the normal anatomy proved futile, and the barbaric nature of our dissections became exaggerated to me when the benefits of the process were removed from the equation. At the end of the day, however, even these seemingly pointless experiences provided some valuable insight. It was a slow process, but I forced myself to change my outlook on the GI labs to avoid becoming jaded. After observing the gruesome effects of advanced cancer on such a personal level, I want to use the experience as a catalyst to take better care of myself and my future patients.

Despite its jarring nature, anatomy lab was an unparalleled learning experience in both an academic and a personal sense. There truly is no better way to cement our anatomy lecture content than to uncover the structures in a body not unlike our own. I often get complimented on my anatomy notes because I draw everything out, and I started taking notes in this way because lab has taught me to see the human body as a legitimate work of art. By dissecting and feeling our way through the body from head to toe, we’ve learned to perceive our bodies as immensely plastic, yet fragile, creations. Having the privilege to open up and learn from a complete stranger provides a unique insight into just how vulnerable and selfless human beings can be, even at the end of their lives.

Charting the course of my own emotions throughout this process has helped me realize my morals and my reasons for pursuing medicine on a deeper level. When I learned to swim in elementary school, my teacher had us jump into the deep end of the pool and guided us in the water with one hand as we gained our bearings. I am beyond grateful that, although anatomy lab felt like jumping into deep water once again, we were able to stay afloat thanks to the sympathetic guidance of our capable professors. Here’s hoping we can all use our newfound knowledge to better care for our patients down the road.


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