AndyPeckham.com

July 1, 2008

Triage

Definition: the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors (http://medical.merriam-webster.com/medical/triage)

“This is mass casualty disaster,” I said.  “You have to assess each one and determine whether there is a chance of survival.  If there’s no respirations and no pulse, you have to move right on to the next one.  There’s no time to waste on the ones that won’t make it anyway.”

I said this 30 seconds before starting my fourth organic chemistry exam.  Ironically enough, a few hours later I would be doing chest compressions on a man without respirations or a pulse.  But that’s another story.  The last exam had destroyed me.  I had gotten behind in the reading because of doing a swiftwater rescue class with Search & Rescue the weekend before.  I walked out of that exam feeling worse than I had ever felt about a test in my life.  I was certain I had failed it, and didn’t know what it meant.  Did it mean I was going to fail o-chem?  Did it mean I didn’t have what it takes to finish premed, much less get into med school?  I ended up getting a 62% on the exam the week before, and the fact that the class average was 58% was small consolation.  I felt better prepared for this one—I had actually been able to finish the chapter and do quite a few practice problems.

The exams are passed out and we put our names on the cover page.  You can feel the anxiety in the air, and your classmates either have intense looks of concentration, or nervous smiles.  The professor writes the current time on the chalkboard and tells the class they can begin.  One hour and ten minutes to do an amount of problems which takes you 3-4 hours to do at home.  You briefly scan each page to get an idea of what’s ahead, and then you begin the first problem.  When you get to a problem that you don’t know how to do right away you star it with a shaking hand and move on to the next one.  You work on that for 5 minutes and only figure out half of the steps of the mechanism to get to the final product before running into a wall.  When your mind is blank for more than 15 seconds you star it and move on.  You’ve got absolutely nothing for the next one, so you star it and move on.  Finally a kind of problem that is familiar.  The questions get harder on each page and then you get to the end and there is 30 minutes left.  You look back and half of the problems have been starred and skipped, and a lot of the ones that haven’t been starred you know are only half finished.

“Anti-Markovnikov addition? Hofmann elimination?  SN2 substitution or E2 elimination?  Intramolecular epoxide ring formation?  Dimethylsulfoxide solvent?  Diastereoisomers?  How the heck do I make a triple bond and add an aldehyde?….”

You start scribbling down whatever first comes to mind.  If you know it somehow becomes this but don’t know how it gets there, you just draw it in anyway and see if you can figure out what it reacts with to get to the next step.  You start drawing arrows for the electron pushing even if you don’t know if it’s possible for the electrons to go where they are going.

10 minutes left.  Really, even though you have no clue on some of them, you just can’t leave them blank.  “I don’t know why this synthesis pathway is better than the other one exactly, but it must be because the other one could form multiple products because of competing reactions.”  “Time.  Please hand in your exams.”  You let out a big sigh.  If only you had another half hour…  But at least you triaged well.  You answered the ones you knew, and hopefully got a few partial credit points on the ones which you only knew half of the mechanism.  You even made a long shot guess on the last problem of the test, which will probably not give you any points, but at least you didn’t leave it blank.

I felt better about that test than the last one.  And now it’s time to cram for the physics exam.  When that’s done it’s time to start an 18 hour shift with the ambulance.

I’ve been learning a lot about triaging my tasks.  Each hour of the day needs to be assigned to something.  If I’m not doing homework while I’m eating I feel like I’m wasting time.  I’ve lost over 15 pounds in the last year.  Usually only 5 hours or less goes to sleeping.  I figure one cup of coffee equals one hour of sleep anyway.  But I really don’t like to be in a position where I have to be triaging everything!  I am a perfectionist, and the idea of not doing everything completely and to the best of my ability bothers me.  And then I start getting stressed, and sleep deprived, and become irritable.  And then I don’t like who I’ve become.  I know there are a lot of lessons to be learned from this…

July 12, 2008

It turned out that I got a 54% on that exam.  The class average on that exam was 48%.  Lowest test score of my life probably.  That was really discouraging.  The final exam was the day after my birthday, so all I did on my birthday was study till 3 am.  I ended up doing “well” on the final exam, with a 70%.  Never would have thought that a 70% could be good.

Good news: by some MIRACLE, it turns out I got a B+ for that class!  The teacher insisted all along that the class would not be curved, but I think he might have after all.  That was a huge relief, because I was expecting a C, which would mean I would have to retake the class this fall.

I’m realizing that I have not been trusting God and his plans and his timing.  For some reason I got my mind set on finishing all my premed classes in a year and applying to med schools this summer instead of next summer.  I know that my pride gets in the way often, when it comes to taking on more than I can really handle.  You have to apply a year before you start, so if I can pull this off I could start med school Fall 2009.  Problem is, a lot of med schools don’t recognize my degree from prairie, so I have to plan on finishing a second bachelor’s degree in case, which sets me back again.  Even if I can somehow get a B- in this second O-chem class I’m in now, which is harder than the first, I don’t know if I’ll finish my application to med schools in time this summer.  I have a whole lot to do before then, including preparing for the MCAT at the end of August.

Another highlight: Last weekend I got to go to the wedding of one of my good friends from high school.  She married another of my friends from highschool.  I got to see several of my close high school friends, and my dorm parents and their family, who are like a second family to me.  That was a very encouraging time, and definitely a blessing from God.  I wouldn’t have been able to afford the trip if it weren’t for several people donating money for my plane ticket.  Another blessing this summer: there are two other guys in my O-chem class who have become good friends.  Both are interested in medical missions, and are also into doing outdoor activities, so that has also been a huge blessing for the summer.  God is good!

Just got to survive 4 more weeks.  Search and rescue has been real busy lately (4 calls this week, 2 today), but I don’t have a hospice patient I’m visiting at the moment.

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