M3 Mania I

After today, we should now be able to complete a head to toe physical exam (theoretically). In our last patient education/physical exam session, we learned about how to complete a clinical breast exam, which involves a visual inspection (from four different views), lymph node palpation (in the axilla and near the collar bone) and the breast exam. Like the female and male pelvic exams, we were taught by patient educators who demonstrated the exams on themselves before walking us through each step of the exam, as well as teaching us important points about establishing rapport.

The breast exam is not just about the breast as we think of structures contained in the bra. In performing the breast exam, it helps to think of an imaginary rectangle drawn around the breast, starting from under the arm going up to the clavicle along the sternum and down just below the breast. Using a light, medium and deep palpation with the pads of our fingers, we feel the fatty and glandular tissue of the breast as we move our fingers in a cork-screw pattern vertically on the tissue.

As I performed the exam, I said aloud "light, medium and deep" to help coordinate my actions. To completed a thorough exam, when you are learning, it takes some time (more than 2 minutes). And it's always hard to make sense of what you are feeling; everything feels kinda of lumpy and bumpy. "Like a bunch of grapes," said our patient educator. And every patients tissue will obviously feel different.

In explaining the exam to our patients, our patient educator made a good point- we perform a thorough exam to establish a baseline, which will serve to us detect any change (the other "C" word), not just for cancer.

In completing my first breast exam, I know it will take lots of practice to master the fine art of detecting subtle tissue changes that may come in the form of pea-sized lumps. "One day, you may be saving lives," our educator said as we closed the session. Maybe.

Other than performing a clinical breast exam on one of the nicest and warmest days in November, I spent my Sunday indoors preparing for our first M3 exam. We transitioned from Infectious diseases to the mechanisms, methods and malignancies block, formerly known as the cancer, bench to bedside, block.

Preparing for this exam has been partly a walk down undergraduate memory lane, taking me back to the days of when I majored in genetics and studied cancer as part of my research. Revisiting the genetic basis of cancer and the molecular biology of tumorigenesis has been interesting, especially as we learn the connection and see how the science relates to the clinical picture of a disease that impacts so many people.

Having been personally affected by cancer, it is sometimes difficult to read about the studies that predict five-year survival of patients on certain drugs, or learn about how cancer can recur or metastasize to other organs. It's hard to focus on the biology of a disease, when you can't help but see a face of someone you love who has suffered from the disease. And at the same time, it is promising to hear about the advances made in treatment and understanding the disease.

All in all, this has been a somber block. And Studying for the tomorrow's exam has been especially difficult (story of my medical school life).
M3 Mania continues...homestretch!