Blogger heal thyself: Days at med school, nights on Net
BY ANNE PINCKARD
After an anatomy class Graham Walker, a third-year medical student, discovered he no longer had a shoulder.
The class taught him to see beyond the body's simple function and look at its tendons, bones and complex musculature. But in doing so, he lost sight of the whole. Walker documented his experience on his blog, Over My Med Body! at www.grahamazon.com.
"I used to always think of my shoulder as, well, a shoulder. Y'know—the rounded-off area between your neck and your arm? It always had a definite shape ('shoulder-shaped'), it was fairly solid, and, although it never had any specific boundaries, I kind of had an idea of where my shoulder started and ended," he wrote in an October 2003 entry. "Turns out, I was completely wrong."
For Walker, keeping a blog is more than a documentary of life as a medical student. Rather, it's become a way for him to keep his humanity as he underoges his transformation into a doctor.
Originally from Chicago, Walker considers himself a "big computer nerd" and has been keeping a blog in some form or another since 2002. Before that, he wrote in a journal. Walker, 25, peers out into the world with earnest blue eyes, often framed with silver-rimmed glasses. His blond hair is close cropped and his thin body wound taut with energy. As he talks he throws his arms into the air and raises his voice with exuberance. If it's a day he's working in the hospital he'll be wearing a nice shirt, tie and slacks. Otherwise, he's a T-shirt-and-shorts kind of guy.
His father was a doctor, and though Walker started out as a humanities major at Northwestern University, he decided he would enjoy the challenge of the medical profession more. His early posts on his medical school applications proved popular, and he decided to devote an entire site to the subject. "I figured it would be a fun experience for myself to really look back on what med school is teaching me and to give people an outside view of what it's like to become a physician," he said. "What are the ethical, emotional and social issues you deal with on a daily basis?"
Walker is part of the growing legions in the online phenomenon of blogging. Estimates of the number of blogs are now pushing 41 million. Pretty much any topic is fair game. In fact, if there's a subject you can think of, chances are someone will have blogged about it.
The range of medical bloggers is broad, from long-practicing physicians, nurses and emergency medical technicians to those just starting out and medical students. Some write about the latest discoveries in their specialty or current issues in medical practice; others, like Walker's, are more personal.
"He's not afraid to speak his mind. He writes well. He's entertaining. He's willing to be publicly righteous, angry, upset, amused or unsure," said New York City-based nephrologist and internist Joshua Schwimmer, MD, who has his own blog at www.kidneynotes.com.
Schwimmer said he enjoys reading Walker's blog. "Graham writes for everyone. I imagine it's therapeutic for both him and his readers," he said.
Currently, Walker's site receives up to 1,700 hits a day, with 250 signed up for RSS feeds. He's been interviewed about his blog by US News & World Report.
Squeezing in the time to post for his devoted readers can be tricky, he said. Usually he tries to do it an hour or two before his day starts. Late nights, too, stimulate his writing, he said. Sometimes he'll try to hash out several posts at once and then stagger them throughout the week. Once in a while, he will be struck with a strong desire to post during the day and he can barely wait to get to a computer. He uses WordPress, an open-source Web publishing platform.
Walker's blog is not anonymous, as many others are, and sometimes he becomes concerned his posts, particularly the more controversial ones, might affect his career. But knowing people can identify him serves as an important check for himself, Walker said. He's more likely to think things through rather than post impulsively. If something is controversial, he'll sleep on it and see if he still wants to post it in the morning. He's always careful to protect his patients' privacy, he said.
His first posts documented his nervousness in starting medical school and the anticipation of the life-transforming experience. Walker said he rereads these posts periodically when he feels frustrated with the late-night calls at the hospital and the endless hours of studying to remind himself of why he went to medical school in the first place.
"The $120,000-plus debt, the long hours, the physical and emotional exhaustion, the paperwork, the monotony, the stress; the excitement, the joy, the career, the opportunity, the adrenaline rush, the wonder, the science, the body, the people," he wrote July 2003 in a post titled "Never let me forget." He added, "The bad and the good, the yang and the yin; I want to embrace it fully."
A particularly dark point was during his second year of classes, he said. In order to pass the Boards, the United States Medical Licensing Examination, and progress into the next stage of training, Walker had to memorize countless diseases, drugs and symptoms, he said.
"It's very easy to look at it and think, 'Woe is me.' You work incredibly hard, often you aren't thanked for it or rewarded for it," he said. "But no one put a gun to my head and said, 'Go to medical school.'"
The reward for his hard work was seeing patients for the first time. As part of his third year, Walker is doing his rotations, moving from one kind of practice to another. As his posts reflect, his first rotation, surgery, proved dramatic.
"Next when I was invited to stick my hand in an open patient and feel a liver, a spasming colon, the aorta, and then the beating heart, it was almost too sci-fi to be real. This is a person. MY HAND IS INSIDE A PERSON! I'M INSIDE A PERSON AND THEIR HEART IS HITTING MY HAND!" he wrote in July 2005. "It's even stranger when you take care of the patient after their surgery, and you think to yourself, 'My hand was inside you.'"
During the sparse free time that he has, Walker engages his computer skills to create Web-based programs including MDCalc, a compilation of equations to figure a person's ideal body weight, the amount of calories they burn while resting and more advanced calculations frequently needed in medical practice.
Another program, MDList, stemmed from his desire to solve a problem he encountered in the clinics. He became frustrated trying to decipher lists of patients' medications. Sometimes the names were inaccurately transcribed or written so messily that he couldn't make them out. He didn't feel familiar enough with drug names to be able to make an educated guess. He created MDList, an online program for people to keep track of their medications. Patients can type in their medications, entering the dose, frequency, start date, and the reason for the prescription. They can then manage their drugs by accessing the site or print up a list to take to their doctor.
On his blog, Walker is an unabashed supporter of a single-payer health-care system and frequently posts commentaries supporting legislation to establish such a program or rebutting criticisms of the approach posted on other blogs. His readers appear to be split on the issue, and his writings on this subject tend to elicit the most feedback. The underlying message from critics is that while single-payer health care might be a good idea on paper, it's not practical. Consider this response from a regular visitor to Walker's blog who calls himself "Flea"and is a practicing pediatrician: "Forgive me for saying the following: If and when you strike out into the cold, cruel world as I have done, you might understand what I'm talking about."
Nonetheless, Walker remeains steadfast in his opinion. "That's not to say in 20 years, when I'm in their position, I may not feel the same way," he said. In fact he already sees a change in his attitude since he started med school. "Oh I totally do and I don't like it," he said. "I think, I was so naive back then, or the flip side of that, I'm so cynical now."
But by blogging about his experiences, he hopes to hold on to his idealism about medicine while demystifying what happens at medical school for readers outside of the field. "Unless you know a medical student, you don't really know what it's like to be in anatomy class, to see a patient by yourself for the first time," he said. "It's important for people to understand doctors are human, that we are not miracle workers, that we do our best, but we make mistakes."
He still has a long journey before he officially becomes a doctor - another year of school and then his residencies. But he said he won't feel like a real doctor for probably a decade or so. He anticipates a major breakthrough sometime during his residency, he said. He'll know when it happens. "It's when everything becomes second nature," he said.
Anne Pinckard is a science-writing intern in the Office of Communication & Public Affairs at the School of Medicine.